Basophilic Material Research Articles

Central Blindness Associated with a Pituitary Adenoma in a Mare

Background: Pituitary pars intermedia (PI) adenoma is a benign adenohypophysis neoplasm, rare in Brazil, which may compress adjacent structures and lead to dysfunctions of the endocrine organs. The most affected species are equines, particularly aged animals. This neoplastic disease is often associated with Cushing's syndrome, when the pituitary-adrenocortical axis is affected. However, this neoplasm is seldom associated with clinical blindness. This paper describes a case of pituitary pars intermedia (PI) adenoma which caused blindness in a mare.Case: An emaciated, blind mare that had difficulty finding water and food was referred to “Hospital Veterinário de Grandes Animais” of “Universidade Federal Rural do Rio de Janeiro”, in Seropédica, state of Rio de Janeiro, Brazil, and later to the “Setor de Anatomia Patológica” (SAP/UFRRJ) for necropsy. During necropsy it was found that the animal’s pituitary gland consisted of a circumscribed globous mass measuring 3.5x2.5x2.5 cm, symmetrical and well delimited at the sella turcica. Several organs were collected, fixed in 10% formalin and then processed for histological examination. The brain was subjected to serial cleavage along the path of the vision organs. All collected tissues were stained with hematoxylin and eosin; the pituitary was stained with Schiff Periodic Acid (PAS) to differentiate neoplastic cells and with Luxol Fast Blue to evidence demyelination. Histopathology found that the pars intermedia (PI) was thickened and compressed the neurohypophysis and adenohypophysis. Cells were arranged in a disorganized manner or formed follicles or cysts containing eosinophilic material (colloid), with granules strongly positive after staining with PAS. Proliferated cells were large, polyhedral to ovoid, and contained clear basophilic granular material. The nuclei were spherical to ovoid and there were light anisocytosis and anisocariasis. Cysts were frequently found in the pars intermedia (PI) and occasionally in the pars distalis. Mitoses were rare, less than one per field of greatest increase. In some areas of the pars intermedia (PI), cells were arranged in a solid manner forming spherical sub-nodules. An orange yellow pigment was observed in the pericary (lipofuscinosis) in various neurons of several areas of the central nervous system and of the trigeminal ganglion. In the optic tract, there were areas with moderate demyelination, evidenced by Luxol Fast Blue staining, and macrophages characterizing the so-called digestion chambers. In the right and left lateral geniculate nuclei a focal area of neurons with pyknotic and peripheral nuclei, marginal Nissl substance (central chromatolysis) and atypical and reactive astrocytes was observed, with increased volume, evident cytoplasm and nuclei with marginated chromatin which was sometimes reniform.Discussion: This paper presents the pathological findings obtained from a mare with central blindness due to pituitary pars intermedia adenoma. The analysis of the structures affected and correlation of alterations with the respective clinical signs are compared with alterations in other areas of the pituitary which generate clinical signals not observed in this mare, but which occur more often in equines with tumors in that organ. Thus, central and bilateral blindness was associated with compression of the optical tracts by the neoplastic mass and consequent death of neurons of the lateral geniculate nucleus. Pituitary PI adenoma should be considered as a differential diagnosis for blindness.

Characterization of Novel Injectable Lifting Agents Used in Colonic Polyp Removal: An Emerging Amyloid Mimic.

Colon polypectomy can require an injection of a submucosal lifting agent to fully visualize and completely remove the polyp. To the best of our knowledge, this is the largest morphologic series on the novel lifting agents Eleview and Orise. The study consisted of 1 polypectomy and 8 colon resections from 9 patients: 6 women, 3 men (mean age=64 y); Orise=6, Eleview=3; the median time interval between injection and resection=16 weeks. Pathologic diagnoses of the polyps included tubular adenoma (n=4), tubulovillous adenoma (n=4), and sessile serrated adenoma/polyp (n=1). We report that a histologically processed Orise aliquot from the manufacturer showed similar histology to that seen in the specimens from patients with confirmed Orise injection. The morphology of the agents in the patient specimens changed with time status postinjection: immediate resection of the lifting agent showed basophilic, amorphous, and bubbly-extracellular material with prominent hemorrhage, and resection ∼3 months after lifting agent injection showed prominent hyalinized, pink-amorphous ribbons and globules with a foreign body giant cell reaction and fibrosis. The epicenter of the lifting agents was in the submucosa, and the agents were neither refractile nor polarizable. Because of the morphologic overlap with amyloid, 5 cases were stained with Congo Red, and all cases were negative. In conclusion, awareness of the morphology of these new lifting agents is important for accurate diagnosis and to avoid the diagnostic pitfall of amyloid. These lesions can be definitively distinguished from amyloid by their nonreactivity on a Congo Red and familiarity with their characteristic clinicopathologic presentation.

Adenosquamous carcinoma of the cervical oesophagus in a dog

ABSTRACT: A 9-year-old male Shih Tzu dog presented with a mass on the ventral region of the neck and developed ptyalism. Radiographs revealed a radiodense nodule located in the mid-third of the oesophagus compressing the trachea. Preoperative cytology showed large neoplastic cells with abundant vacuolated cytoplasm arranged in clusters. The nodule was removed by oesophagectomy and submitted for histopathology. Microscopically, the oesophageal mass was multilobulated and unencapsulated. It had a mixed cellular growth pattern with areas showing squamous and glandular differentiation. The squamous component of the tumor was formed by solid strands of neoplastic epithelial cells; many neoplastic cells had undergone central keratinization and sometimes formed keratin pearls. The deeper adenocarcinomatous portion of the tumor consisted of tubules filled with slightly basophilic mucinous material. Histological and immunohistochemical examination confirmed the diagnosis of primary adenosquamous carcinoma (ASC) of the esophagus. This is the first report of primary ASC of the cervical oesophagus in a dog.

Delayed Foreign Body Granulomas in the Orofacial Region after Hyaluronic Acid Injection.

Objective: To evaluate and analyse granulomatous reaction caused by intradermal injections with hyaluronic acid (HA) fillers in the orofacial region. Methods: A retrospective review of 11 cases of foreign body granulomas caused by HA fillers was performed. Demographic data, clinical symptoms, imaging features, treatments, pathology results, history of facial cosmetic procedures and prognosis were reviewed. Results: Most of the cases appeared as painless palpable nodules with no significant growth, located in the cheeks, chin, lips or temples. The nodules were excised, and pathological examination revealed amorphous basophilic material surrounded by foreign body giant cells and macrophages. No patient’s clinical and pathological diagnosis was linked to HA during the first appointment. During follow-up, all patients admitted that they had received dermal filler injections from 3 to 10 years previously. Most of the patients had a favourable prognosis; one patient complained of facial asymmetry and another reported mild pain in the upper lip after surgery. Conclusion: The increase in the number of cases showing delayed complications caused by HA fillers merits closer clinical attention. A thorough understanding of the patient’s medical history and biopsy specimen are necessary to make a definite diagnosis and offer appropriate treatment.

ONCOCITIC VARIANT OF CENTRAL MUCOEPIDERMOID CARCINOMA: A RARE CASE REPORT

Mucoepidermoid carcinoma (MC) constitutes a heterogeneous lesion and may present histologic variations that make the diagnosis difficult to establish. A 45-year-old women presented to a referral center complaining of a 10-year increase of volume in the left posterior mandible, associated with dental displacement, with no sign of oral mucosal involvement. Computed tomography evidenced a large hypodense area, with well-defined limits, cortical bone thinning, and a discrete area of solution of continuity. Incisional biopsy was performed with diagnostic hypothesis of dentigerous cyst or ameloblastoma. Histopathologic analysis revealed a malignant neoplasia with glandular differentiation, presenting a prominent component of large oncocytoid polygonal cells, such as cells with squamous, basaloid, columnar, and mucous aspects. Multiple cystic and ductiform spaces, sometimes containing basophilic mucoid-like material, were observed. Histochemical and immunohistochemical reactions were also performed, and the diagnosis of oncocytic MC was established. Tumor resection and mandibular reconstruction with microsurgical fibular graft were considered for treatment.

OROFACIAL GRANULOMAS AFTER INJECTION OF COSMETIC FILLERS: A CASE REPORT

The increasing demand for cosmetic procedures in the orofacial area results in a growing number of complications, including the development of foreign body granulomas. A 55-year-old woman presented with submucosal and subcutaneous nodules that were firm on palpation, which had arisen approximately 30 days earlier in the right buccal mucosa and in the face (cervical, submentonian, and submandibular regions). The diagnostic hypothesis was lymphoma, but after the clinical examination, the patient reported having undergone facial filling procedure 1 year before. Ultrasonography showed nodular images suggestive of reactive granulomas. Preoperative tests were requested, and incisional surgical biopsy was performed. Histologic analysis showed granulomatous reactions associated with the use of hyaluronic acid (accumulation of amorphous basophilic material) and polymethylmethacrylate (refringent material, without dye impregnation). The patient was unaware of the facial filling with polymethylmethacrylate.

THE STRUCTURE OF LYMPHOID-ASSOCIATED EPITHELIUM OF PEYERS’ PATCHES OF THE ALBINO RATS’ SMALL INTESTINE

Over the past two decades, there have been many publications dealing with the further development of an urgent issue on the immune system of the mucous membranes of the digestive tract, called mucoseassociated lymphoid tissue (MALT), which includes spheres of innate (non-specific) and adaptive (specific) immunity. Most structured formations and indicators of adaptive immunity in the intestinal mucosa are lymphoepithelial formation (Peyer's patches). The data on the formation of the peripheral part of the immune system are carried through the epithelium, mechanisms of interaction between pathogenic intestinal microflora and immunocompetent cells, thereby initiating the development of immune responses in the mucous membranes. A concept has long been established in the literature, according to which a leading role in mediating these reactions belongs to a special type of enterocytes, called M-cells. Before the concept of the initial role of these cells in the development of immune responses in the mucous membranes of the intestinal tract they were known as caveolated cells. The purpose of this study was to determine the shape and topological relations of M-cells with other types of enterocytes, and also with lymphoid elements Peyer's patches of the small intestine. 30 mature albino male rats weighted 200,0±20,0 g were involved into the study. After vivisection, which was carried out by an overdose of thiopental anesthesia (75 mg / kg of animal body weight intramuscularly in the upper third of the thigh of the hind paw) [1] in compliance with the requirements for dissection of the abdominal cavity, the entire complex of the gastrointestinal tract was removed, which was preserved in 10 % formalin solution. Subsequently, short sections of the small intestine, containing Peyer’s patches, were selectively excised. Finding the latter was not difficult due to their clear visualization on the external (nonmesenteric) surface of the small intestine in the form of whitish spots. The specimens, after washing from formalin and dehydration in alcohol of increasing concentration, were embedded into paraffin blocks, from which serial sections of 4 µm thick (Microm HM 325) were obtained with subsequent staining with hematoxylin-eosin and Van Gieson. Their study and documentation was carried out using the “Konus” light microscope equipped with the Sigeta DCM-900 9.0MP digital microphoto attachment and the Biorex 3 program (serial number 5604) adapted for these studies. In the study of many series of paraffin sections stained with hematoxylin-eosin, it was found that while maintaining the general shape of the structure, lymphoid nodules are susceptible to plastic variability, which depends on situationally changing factors of antigenic effect, i.e., functional polymorphism is characteristic of them. This is especially true of their lymphoidassociated epithelium, which appears in a rather diverse form, which depends not only on the section angle, but also, probably, on its reactive state. Thus, in some cases it is a relatively even monolayer of intestinal epithelium, consisting mainly of absorbing enterocytes, among which the most distinct are goblet cells. At the same time, it draws attention to itself that in the apical sections of some of them there are clear signs of rupture of the plasmolemma and the presence in the cytoplasm of basophilic granular fibrous material of an unknown nature. Along with this picture, other histological sections of large lymphoid nodules of Peyer's patches of the small intestine demonstrate a different configurational character of lymphoid-associated epithelium, in which the cluster principle of cell distribution in the form of limited portioned sets is clearly noted. While maintaining the general structural shape, Peyer's patches were found to be subjected to plastic variability, which depends on situationally changing factors of antigenic exposure, i.e., functional polymorphism is characteristic of them. This is especially true of their lymphoid-associated epithelium. Identification of M-cells using only traditional histological methods in practice is complicated. And yet, in the process of a focused study of serial paraffin sections, it was possible to detect some morphological signs indicating their location.

ATYPICAL RADIOGRAPHIC PRESENTATION OF OSSIFYING FIBROMA

<h3>Background</h3> <i>History</i>: A 21-year-old female presented with a 1-year history of pain in the mandibular right premolar region. <i>Radiographic findings</i>: The multidetector computed tomography (MDCT) images showed a 5 × 1.7 cm radiolucent lesion of the mandible extending from the left canine, across the midline, to the right second molar. There was thinning of the buccal and lingual cortices, with displacement of the buccal cortex. There was evidence of thin trabeculae in the buccal cortical area. There was displacement of the first and second premolars in the region, with evidence of resorption of the roots of the incisors and right first and second molars. The inferior alveolar canal was not visualized within the region of the lesion, and it was difficult to determine if there was displacement or destruction of the canal. <i>Differential Interpretation</i>: The differential interpretation included giant cell lesion, ameloblastoma, odontogenic keratocyst, and odontogenic myxoma. <i>Microscopic Description</i>: Microscopic examination revealed multiple, small, round to ovoid islands of demineralized osteoid and acellular basophilic material, scattered amidst a dense fibrocollagenous connective tissue, populated with bland, occasionally stellate, fibroblasts. <h3>Discussion/Conclusions</h3> The lesion was diagnosed as benign fibro-osseous lesion consistent with a cemento-ossifying fibroma. The MDCT images provided a challenging interpretation in this case. On the basis of the images, the more obvious diagnosis was toward a benign cyst or tumor, such as a giant cell lesion, with differential diagnoses of ameloblastoma, odontogenic keratocyst, or odontogenic myxoma. However, we should not rule out aggressive ossifying fibromas among the differential diagnoses as this case clearly proves with such typical features.

Ischemic Toe Ulceration Due to Foreign Body Embolus From Hydrophilic Polymer-Coated Intravascular Device

Hydrophilic polymer coatings are now widely applied to catheters and other intravascular devices used in neurovascular, cardiovascular, and peripheral vascular procedures. Emboli consisting of these materials have been previously identified in biopsies and autopsies following pulmonary infarction, stroke, gangrene, or death. We report a case involving a nonhealing foot ulcer that appeared following cardiac catheterization, stenting, and automatic implanted cardiac defibrillator (AICD) implantation in a patient without other evidence of significant peripheral artery disease. An 85-year-old woman with chronic atrial fibrillation, aortic valve stenosis, and coronary artery disease underwent coronary stenting and AICD implantation for ventricular tachycardia and syncope. She developed a toe ulcer shortly thereafter, which did not respond to standard treatment. A histological examination following amputation of the toe found amorphous basophilic material in capillaries adjacent to the edge of the ulcer, which was similar to material associated with hydrophilic polymer coatings. Ischemia and infarcts following endovascular procedures should not be presumed to result from thrombus or vascular disease, even if intravascular devices appear intact or properly placed after the procedure. To help establish the incidence of ischemia caused by hydrophilic polymer device coatings, if excision of ischemic or infarcted tissue after endovascular procedures using coated devices becomes necessary, the tissue should be evaluated microscopically. Surgeons should also consider the tolerance of distal organs to infarct or ischemia when selecting coated intravascular devices.

Activated mTOR signaling pathway in myofibers with inherited metabolic defect might be an evidence for mTOR inhibition therapies.

Background:Abnormally activated mechanistic target of rapamycin (mTOR) pathway has been reported in several model animals with inherited metabolic myopathies (IMMs). However, the profiles of mTOR pathway in skeletal muscles from patients are still unknown. This study aimed to analyze the activity of mTOR pathway in IMMs muscles.Methods:We collected muscle samples from 25 patients with mitochondrial myopathy (MM), lipid storage disease (LSD) or Pompe disease (PD). To evaluate the activity of mTOR pathway in muscle specimens, phosphorylation of S6 ribosomal protein (p-S6) and p70S6 kinase (p-p70S6K) were analyzed by Western blotting and immunohistochemistry.Results:Western blotting results showed that p-p70S6K/p70S6K in muscles from LSD and MM was up-regulated when compared with normal controls (NC) (NC vs. LSD, U = 2.000, P = 0.024; NC vs. MM: U = 6.000, P = 0.043). Likewise, p-S6/S6 was also up-regulated in muscles from all three subgroups of IMMs (NC vs. LSD, U = 0.000, P = 0.006; NC vs. PD, U = 0.000, P = 0.006; NC vs. MM, U = 1.000, P = 0.007). Immunohistochemical study revealed that p-S6 was mainly expressed in fibers with metabolic defect. In MM muscles, most p-S6 positive fibers showed cytochrome C oxidase (COX) deficiency (U = 5.000, P = 0.001). In LSD and PD muscles, p-S6 was mainly overexpressed in fibers with intramuscular vacuoles containing lipid droplets (U = 0.000, P = 0.002) or basophilic materials (U = 0.000, P = 0.002).Conclusion:The mTOR pathway might be activated in myofibers with various metabolic defects, which might provide evidence for mTOR inhibition therapy in human IMMs.

Displasia cemento-ósea del maxilar: problemas de diagnóstico diferencial a propósito de un caso

Cemento-osseous dysplasia is a benign lesion which affects the jaw bones. It is a frequent incidental finding but no aggressive therapy is necessary. However, it may be confused with more aggressive entities, such as ossifying and cementifying fibroma, which do require treatment. There are no clear-cut histopathological criteria to differentiate between these entities. We present a case of a 13-year old boy who underwent a biopsy of a clinically undiagnosed maxillary lesion. Histopathological analysis revealed moderately cellular fibrous tissue with bone trabeculae with no osteoblastic rimming and clusters of intensely basophilic material corresponding to cementum. The final diagnosis was cemento-osseus dysplasia. The main histopathological features important in the distinction of these entities are discussed.

Chondroitin sulfate isolated from the secretion of the venom-producing parotoid gland of Brazilian bufonid

The parotoid gland of bufonids is characterized as a specialized integument region, formed by different gland types. The secretion elaborated by the largest glandular alveoli has been related to animal chemical defense and is constituted by granular protein content, associated with a basophilic and alcianophilic material with features of glycoconjugates. This study aimed to identify and characterize the glycoconjugates in the secretion of the largest granular gland of the parotoid gland of Rinella icterica by histochemical and immunohistochemical techniques at light microscopy, biochemical methods, and nuclear magnetic resonance spectroscopy. Our results showed that the glycoconjugate content contains a mixture of chondroitin‑6‑sulfate (C6S) and chondroitin-non-sulfate (C0S). Thus, chondroitin sulfate probably plays an important role in gland physiology, probably protecting the protein content while inside the secretory portion.

Invasive Ductal Mammary Carcinoma in a Cow

Background: Mammary gland carcinoma is a malignant epithelial neoplasm that can be classified as solid, papillary, ductal, invasive micropapillary, or invasive ductal. They are rarely diagnosed in livestock animals. Reports describing the breast as primary site of tumor in cows are scarce. In this case report, pathological and clinical findings of primary carcinoma ofthe mammary gland in a cow are reported.Case: A 7-year-old crossbred pregnant cow exhibited an increase in volume in the posterior region of the udder. Palpation raised suspicion of mastitis. The prefemoral lymph nodes (LNs) were enlarged. After calving, the clinical condition worsened, and edema was observed in the ventral region, from the udder to the neck. Poisoning by Amaranthus sp. was suspected. The cow died fifteen days after calving. Necropsy was performed. The affected mammary gland and its LNs, fragments of abdominal organs, brain, pelvic limbs, and udder skin were routinely prepared and stained with hematoxylin and eosin. Gross examination revealed significant alterations in the mammary gland, and in the mammary and prefemoral LNs. The mammary gland was firm and swollen; with loss of normal architecture, and released purulent, pinkish, fetid contents. The mammary LNs were enlarged, with diffuse coalescentmultifocal lesions, loss of corticomedullary delimitation, and the content was similar to that observed in the udder. The internal prefemoral LNs were also enlarged and contained the same fetid contents. Histopathology revealed proliferation of neoplastic ducts coated by numerous neoplastic cells; some areas were solid. There was moderate to severe pleomorphism, with moderate anisocytosis and anisokariosis. Most of the cells had vesicular nuclei, with up to two evident nucleoli. Other cells had dense chromatin, and moderately eosinophilic cytoplasm. There was marked cell dissociation, and cell detachment. The central portionsof the ducts were necrotic, with a predominantly neutrophilic inflammation. The mitotic index was low, but some areas had up to four mitotic figures per high power field. Numerous areas exhibited multiple foci of deposition of organized granular basophilic material, interpreted as mineralized areas, and stained positively for Von Kossa stain. Some areas of the mammary gland exhibited proliferative acini and ducts, composed of a single layer of cuboidal or columnar cells with moderately eosinophilic, vacuolated cytoplasm, and a basal rounded nucleus of generally aggregated chromatin (mammary hyperplasia). Many acini were dilated, and some contained circumscribed basophilic material (corpora amylacea). The structural architecture of the LNs was altered by malignant neoplastic infiltration, similar to that found in the mammary gland. No metastatic lesions were detected in the other organs. Immunohistochemistry (IHC) was performed using the streptavidin-biotin-peroxidase technique. Anti-pan-cytokeratin and antivimentin antibodies were used. Neoplastic cells exhibited strong and uniform cytoplasmic immunoreactivity for pan-cytokeratin. Expression of vimentin was absent in the neoplastic cells, but was present in the connective tissue associated with the neoplasm.Discussion: Invasive ductal mammary carcinoma was confirmed by histopathological and IHC analyses. Edema can be explained by the neoplasm in the mammary gland and in the mammary LNs, with accumulation of fluid in the interstitium, caused by growth of the tumor and compression of large blood and lymphatic vessels. IHC confirmed the epithelial origin of the tumor and demonstrated the presence of epithelial tumor cells in the LNs, proving to be metastatic. Similar findingswere reported in a cow with a highly aggressive secretory mammary carcinoma, in which neoplastic cells exhibited immunoreactivity to cytokeratin, indicative of their epithelial origin.Keywords: histology, immunohistochemistry, neoplasms, ruminant.

Uterine Paramesonephric Cysts in Sprague-Dawley Rats from National Toxicology Program Studies.

Congenital uterine wall cysts arising from paramesonephric (Müllerian) and mesonephric (Wolffian) ducts are typically incidental findings in most species. We used immunohistochemistry to characterize and determine the origin of uterine cysts in Sprague-Dawley (SD) rats from multigeneration studies conducted by the National Toxicology Program. Subserosal uterine cysts were observed in 20 of the 2,400 SD rats evaluated in five studies, and 10 cysts were characterized for this study. Single cysts were unilocular, fluid-filled, and occurred throughout the uterus. Microscopically, all cysts had a well-developed smooth muscle wall, lined by flattened to cuboidal, sometimes ciliated, epithelium that stained intensely positive for cytokeratin 18 and paired box protein 8 (PAX8). Most cyst epithelia displayed weak to moderate positivity for progesterone receptor (PR) and/or estrogen receptor α (ER-α), as well as were negative for GATA binding protein 3 (GATA3). Cyst lumens contained basophilic flocculent material. The cysts appeared to be developmental anomalies arising from paramesonephric tissue based on positive PAX8 and ER-α and/or PR staining. Additionally, 70% of the cysts lacked GATA3 expression. Taken together, the subserosal uterine cysts observed in adult rats in these studies most likely arose from the paramesonephric duct.

Papanicolaou Cytology as a Suitable Technique for a Diagnostic Approach to an Adverse Reaction to Polyalkylamide Gel Filler

To the Editor: Mr. Editor: the use of fillers in cosmetic dermatology has increased in recent decades.1 However, there is not yet a perfect material because all of them can induce adverse reactions, although some fillers are known to be riskier than others. Sometimes these reactions can be serious and require early treatment.2 We present a clinical case of a severe inflammatory reaction by polyalkylamide gel (Bio Alcamid), where Papanicolaou cytology allowed us to perform an early diagnosis. We present a 59-year-old woman referred to our service by her primary care physician because of a left facial cellulitis that did not improve with antibiotic treatment. The examination revealed a warm erythematous plaque with ill-defined borders located in the left periorbital area and cheek (Fig. 1, up). There were palpable but not fluctuating subcutaneous nodules, not attached to deep tissues of the face. An ultrasound was performed showing multiple round hypoechogenic lesions with posterior reinforcement and without visible vascularization in Doppler mode. A punch biopsy was performed, and yellowish gelatinous material drained from the incision (Fig. 1, down). A sample was taken to perform a Papanicolaou stain, where we observed a basophilic amorphous material surrounded by an intense inflammatory infiltrate constituted mainly by neutrophils and erythrocytes (Fig. 2). The patient was treated with 30 mg of oral prednisone and systemic antibiotic therapy. In addition, a new suborbital incision was made to drain the material that still persisted after the biopsy. The lesions resolved completely within 10 days of treatment. The skin biopsy finally confirmed the diagnosis of late adverse reaction to polyalkylamide gel (Fig. 3). The filling material was visible as an intensely basophilic, nonvacuolated amorphous material that occupied the whole deep dermis and was surrounded by red blood cells and an intense inflammatory reaction.FIGURE 1.: Erythematous plaque with ill-defined borders located in the left periorbital area and cheek. A yellowish gelatinous material drained from the incision after of punch-biopsy.FIGURE 2.: Papanicolaou stain shows a basophilic amorphous material surrounded by an intense inflammatory infiltrate constituted by neutrophils and erythrocytes.FIGURE 3.: Skin biopsy shows a basophilic, nonvacuolated amorphous material that occupied the whole deep dermis and was surrounded by red blood cells and an intense inflammatory reaction.Each filler presents specific histopathological features, so it is important to know these features and be able to recognize them.3 Cytology can be a useful technique to guide the diagnosis faster than conventional skin biopsy and offer an optimal early treatment. To the best of our knowledge, there is only 1 article analyzing the cytological characteristics of the polyalkylamide gel by Papanicolaou staining.4 The view of an amorphous basophilic material surrounded by inflammatory cells and erythrocytes in the cytology is similar to the findings in the histopathological analysis. As a conclusion, we propose Papanicolaou cytology as a technique able to offer an adequate diagnostic approach to adverse reactions to polyalkylamide gel. Further studies are needed to confirm our findings and to analyze the cytopathological correlation of this technique on other filler materials.

Outbreak of Monensin Sodium Poisoning in Horses Associated with Consumption of Mineral Supplement Based on Sugarcane Molasses

Background: Sodium monensin is a molecule of the group of ionophores antibiotics (IAs) of the polyether carboxylic type produced from the fermentation of Streptomyces cinnamonensis. Cases of IA poisoning in animals usually occur accidentally. Fatal poisoning in horses, a non-target species and with particular sensitivity usually occurs by the consumption of these products from the toxic dose of 2-3 mg/kg. This report aims to describe the epidemiological and clinical-pathological aspects of an outbreak of ionophore antibiotic poisoning in horses due to the consumption of mineral supplementation indicated for ruminants based on sugarcane molasses.Case: Two horses were necropsied. During necropsy, fragments of various organs were collected and fixed in 10% buffered formalin, routinely processed for histology and stained with hematoxylin and eosin. The information obtained from the animal trainer was that 19 horses received approximately 25 kg of low moisture mixture based on sugarcane molasses, enriched with macro and micro minerals, vitamins and additives containing 1000 mg of monensin/kg in the trough. One day after receiving the product, five horses began to develop ataxia, reluctance to move, difficulty of accompanying the herd and arising. Out of the five, three died after three days of evolution, one after six days (equine 1) and another after 15 days (equine 2) [morbidity 26.31%]. At necropsy, diffuse pallor was observed in the gluteus medius, quadriceps femoris, semimembranosus, biceps brachii and deep pectoral muscles. Microscopically the muscle fibers were tumefied with hypereosinophilic sarcoplasm of homogeneous appearance and with loss of striations, pynotic or absent nuclei (necrosis). Multifocal areas of fibers with sarcoplasmic fragmentation were observed, with clusters of irregular eosinophilic debris, flake (floct necrosis) or granule (granular necrosis) aspects and focal muscle fibers with granular to crystalline basophilic material (mineralization) and marked multifocal infiltrate, predominantly of macrophages, plasma cells and eosinophils with occasional multinucleated giant cells. In the heart there was focally a extensive area of necrosis and a discrete eosinophil infiltrate.Discussion: The diagnosis of ionophore antibiotic intoxication in horses was established by epidemiological and clinical-pathological aspects. In the horses affected in this outbreak, the intoxication was due to the ingestion of sugarcane molasses containing proportions of monensin, which is not indicated for equines, becoming an unusual source for this animal species. The clinical signs reported in the intoxication under study are mostly locomotors and are directly linked to poor distribution of sodium, potassium and calcium ions in muscle cells, leading to ionic disorders that modify the muscle neurotransmission by deregulating contraction and altering movement. Usually, death of horses poisoned with IAs is related to heart failure due to degenerative cardiomyopathy. However, due to the subtlety of the histological lesions in the heart, we believe that the cause of death may also be related to a possible respiratory failure owing to a degenerative myopathy of the diaphragmatic muscle. The anatomopathological changes found in the skeletal muscles of equine intoxicated with molasses are similar to those described in this species by other authors. Compounds based on sugarcane molasses formulated for cattle containing monensin should be considered as a potential source of poisoning for horses and as a cause of degenerative myopathy, which may be an alert for caring about the handling and feeding of these animals.

PERIPHERAL OSSIFYING FIBROMA: AN ATYPICAL CASE REPORT

A.M.R.C., a 53-year-old female patient, sought the Stomatology Service with the chief complaint “there has been a mass in my mouth for 2 years; it has been difficult to chew”. Intraoral examination revealed a pedunculated growth on the alveolar ridge of the missing posterior teeth on the left side of the mandible. The lesion measured approximately 4 cm, firm to palpation. Panoramic radiographic examination showed irregular radiopacity interspersed in the soft tissue shadow. The lesion was excised and the specimen was sent for histopathologic examination, which revealed the presence of fibrous connective tissue showing proliferation of fusiform cells through the deposition of mineralized material in form of trabecular bone, osteoid and basophilic cementum-like material. The specimen was covered by squamous epithelium and the diagnostic conclusion was Peripheral Ossifying Fibroma. The 2 months follow-up showed complete healing of the oral mucosa. There has not been any evidence of recurrence after 3 years.

Gastric Mucosal Calcinosis

Background: Gastric mucosal calcinosis (GMC) is a rarely encountered disease characterized by calcific deposition in the gastric mucosa which was known to be associated with organ transplantation, end-stage renal disease, hypercalcemia, hyperphosphatemia, gastric neoplasia, medications such as antacids containing aluminum, sucralfate and bismuth, and so on. We describe incidentally found 23 cases of GMC. Methods: We identified 23 cases of GMC from July 2004 to June 2011 from pathology department records. All available inpatient and outpatient medical records including laboratory data were reviewed. Results: 23 cases (9 male and 14 femal: median age of 65.2, range 34-85) were found incidentally by upper gastrointestinal endoscopic biopsy. The microscopic examination showed multifocal basophilic calcific material just beneath the surface epithelium. 14 patients (60.9%) were taking tripotassium dicitrato bismuthate in variable duration from one week to four years, 5 patients (21.7%) were taking aluminum containing antacid and 2 patient (8.7%) were taking both of them. 1 patient (4.3%) showed hypercalcemia with increased parathyroid hormone. The patients had no history of renal insufficiency, organ transplantation or gastric malignancy and had variable symptoms according to other comorbid gastrointestinal diseases, in example, gastritis, gastroesophageal reflux disease, and functional dyspepsia. The endoscopic findings were hyperemia, edema, chalky or salty-white plaque in common and other frequently accompanying feature was spontaneous bleeding. However, endoscopic finding of 2 pateints (8.7%) showed gastric polyp which confirmed GMC pathologically. There was no difference of endoscopic findings between different etiologies. Follow up endoscopy which was available in 8 patients (34.8%) from two months to two years after stopping offending medication showed disappearance of previous noted GMC. Conclusion: Gastric mucosal calcinosis can develop in normal tissue because of altered serum or mucosal biochemical environment associated with therapeutic measures and can be reversed after abstinence of the offending medication.

Etio-pathological study of multiple hepatic abscesses in a goat

Hepatic abscesses occur in all species, most commonly found in cattle, very less in sheep and rare in goats. The abscesses in liver constitute a major economic problem because of liver condemnation and reduced animal performance and carcass yield. During routine necropsy one interesting case of multiple hepatic abscess was encountered which was investigated for pathology and bacterial isolation. Lungs revealed 12–15 foci of abscess in different lobes similar to those observed in liver. Microscopic examination revealed thick and thin fibrous capsules around abscesses, containing basophilic and eosionophilic necrotic material infiltrated with numerous pus cells and some mononuclear cells. From the affected organs, Corynebacterium pseudotuberculosis, Streptococcus sp. and Pseudomonas sp. were isolated and confirmed by morphology, cultural, biochemical characteristics and molecular methods. In the present case the C. pseudotuberculosis could possibly have been a source of the systemic spread with the secondary infection of Streptococcus and Pseudomonas sp. The extensive damage to the liver caused by multiple foci of the abscesses could be the reason for emaciation and death.

Radiographic and histological evaluation of ectopic application of deproteinized bovine bone matrix.

Objective:To evaluate, through radiographic and histological analysis, the tissue reaction induced by a biomaterial based on deproteinized bovine bone matrix (DBBM) in the muscle of sheep.Materials and Methods:Sixteen sheep were used. The animals underwent surgery to insert polyethylene tubes containing the biomaterial in the muscle of the lower back (ectopic site) and were euthanized after 3 and 6 months. Each sheep received three tubes: Group 1 - sham group (negative control - tube without biomaterial), Group 2 - particulate autogenous bone (positive control), and Group 3 - DBBM biomaterial (GenOx Inorg). The material removed was evaluated by radiographic, macroscopic, and microscopic analysis, descriptively.Results:Macroscopic analysis showed that Group 3 had a greater tissue volume maintenance. Microscopic analysis indicated that Group 1 had a higher concentration of dense, thin collagen fibers (3 and 6 months); in Group 2, there was a decrease in the inflammatory process and the deposition of dense, thin collagen fibers (3 and 6 months); in Group 3, the presence of a dense connective tissue was noted, in which the DBBM particles (3 months) were found. On the periphery of these particles, a deposition of basophilic material was found, indicating the formation of mineral particles and the formation of tissues with osteoid characteristics (6 months).Conclusion:Based on the results obtained, it can be concluded that the biomaterial based on DBBM led to the formation of tissue with similar characteristics to an osteoid matrix in a postoperative period of 6 months. However, none of the groups evaluated showed ectopic bone neoformation.