Chronic Inflammatory Cell Infiltration Research Articles

P597 Usefulness of histological monitoring in predicting relapse after de-escalation of thiopurines in Ulcerative Colitis

Abstract Background Thiopurines are useful to maintain remission for ulcerative colitis (UC) and to inhibit immunogenicity in combination with biologics while their long-term use may increase risks of infections and malignancies. Therefore, the risk-benefit balance should be evaluated, and de-escalation needs to be discussed. However, optimal de-escalation strategy such as dosing and monitoring has not been well studied. Methods UC patients in clinical remission (partial Mayo score ≤ 2 and rectal bleeding subscore of 0) who de-escalated thiopurines (dose-reduction or discontinuation) were enrolled. The risk of relapse and changes in Mayo endoscopic subscore (MES) and histological findings after thiopurine de-escalation were retrospectively investigated. The correlation with relapse (treatment escalation (including topical therapy) with the exacerbation of symptoms or rectal bleeding score ≥ 1) was analyzed by logistic regression analysis. Results A total of 69 de-escalation steps (51 dose-reductions and 18 discontinuations) were conducted in 39 patients. The mean duration and dose of thiopurine use were 3.5 years and 66.6mg (converted to azathioprine). Thiopurines were used in combination with biologics in 16 (41.0%). Relapse occurred in 17/69 (24.6%) de-escalation steps (10/17 discontinuations). In 36 de-escalations remaining in remission with available data before and after de-escalations, worsening of MES occurred in 13%, whereas exacerbations of any histopathological finding occurred in 44% (crypt architectural irregularities 25%, chronic inflammatory cell infiltrate 19％, acute inflammatory cell infiltrate 16％, basal plasmacytosis 13%, mucin depletion 13%, crypt abscess 8%). Chronic inflammatory cellular infiltrate (p=0.002), basal plasmacytosis (p=0.008), and acute inflammatory cell infiltrate (p=0.039) at de-escalation were significantly associated with relapse after de-escalation. Nancy Index was also associated with relapse (p=0.011), while MES was not. Conclusion Histological worsening may precede clinical relapse thus may be useful to predict relapse after thiopurine withdrawal.

Histopathological Studies of Eimeria cameli in the intestine of infected one-humped camel (Camelus dromedaries)

Domesticated Old World camels (Camelus dromedarius and Camelus bactrianus) are important for the economy of several countries in Asia, Africa, and the Arabian Peninsula. Coccidiosis is one of the major parasitic diseases in camels which is caused by protozoa of the genus Eimeria, it is considered one of intracellular parasites, transmitted through fecal oral Route. Coccidiosis is responsible for mortality rates of up to 10% in camel calves besides enteritis; also it is characterized by subclinical contagious enteritis in wild and domesticated animals. Although five species of Eimeria were believed to have capability of infecting camels as (E. bactriani, E. rajasthani, E. pellerdyi, and E. dromedarii), the E. cameli is considered the most pathogenic one. A total of 42 samples from small intestine of slaughtered camels were collected from El-Basatin abattoir, Cairo, Egypt. Grossly, the small intestine infected with coccidian showed congested red spots within serosa and mucosa. On histopathological examination, infected tissues showed chronic, hemorrhagic and granulomatous enteritis, the intestinal glands have rose shape appearance in some cases, and complete loss of intestinal gland structure with sever infiltration of chronic inflammatory cells in other cases, hyper eosinophilia and different developmental stages of Eimeria.

Histopathological Studies on the Effect of Taurine Against Etoposide-Induced Acute Liver and Kidney Toxicity in Female Albino Rats

Etoposide (ETP) is a topoisomerase Ⅱ (TOP Ⅱ) inhibitor and one of the leading chemotherapeutic drugs for treating a wide variety of tumors. However, ETP induced hepatotoxicity and nephrotoxicity limits its clinical use. This study aims to investigate the protective potential of taurine (Tau) to mitigated histopathological changes in the liver and kidneys of female albino rats treated with ETP. A total of 18 female rats were divided into three groups; control group, ETP-exposed group received intraperitoneal injection of ETP on the first 3 days of the study for a total cumulative dose of 44 mg/kg to induce hepatotoxicity and nephrotoxicity, ETP + Tau group received ETP as stated previously with 400 mg/kg/day of Tau via oral gavage for 15 days. Sections from the liver and kidney were evaluated under light microscope and ETP-exposed group revealed vascular congestion, chronic inflammatory cell infiltration predominantly lymphocytes, edema, vacuolar degeneration, atypical cells, pyknosis, and necrosis while liver and kidney sections of rats treated with combination of ETP + Tau group exhibited marked alleviation of the histopathological damage. The study concludes that treatment with ETP induced marked structural damages in the liver and kidney and such morphological damages are effectively diminished by administering Tau.

Oncogenic challenge of bromocriptine and L-arginine versus conventional antidiabetics on diethyl nitrosamine-induced liver tumorigenesis in diabetic rats: focus on AMPK activation

Background: Diabetes mellitus (DM) is associated with a spectrum of cancers where the metabolic antecedents, consequences, and therapy might affect cancer risk. The association between hepatocellular carcinoma (HCC) and DM had been confirmed. Approaches to HCC prevention focus on the molecular regulators of the disease process defined as the inflammation-fibrosis-cancer axis. The AMP-activated protein kinase (AMPK) is an interesting metabolic tumor suppressor and a promising target for cancer prevention and therapy. This study aimed to investigate the effects of bromocriptine mesylate and L-arginine on hepatic carcinogenesis on a rat model of hepatic neoplasia induced by diethyl nitrosamine (DENA) and promoted by type-2 DM in contrast to the conventional antidiabetics.Methods: One hundred male Wistar rats were randomly assigned into two sets; control set (normal, HCC, DM, and combined HCC/DM) and treated set where rats received one of the following drugs for another 5 weeks: insulin glargine, glimepiride, metformin, pioglitazone, bromocriptine mesylate, or L-arginine. Bodyweight changes, blood glucose level, liver functions tests, serum C-peptide and alpha-fetoprotein (AFP), and hepatic activated AMPK were assessed beside the hepatic histopathological changes.Results: Equivalent to metformin, bromocriptine and L-arginine treatment significantly reduced AFP, despite their minor glycemic control. L-arginine induced AMPK activation, yet less than metformin. Histopathologic examination revealed a reduction in hepatic intra-lobular chronic inflammatory cell infiltration, steatosis and necrosis by metformin, bromocriptine, and L-arginine. Hepatic necro-inflammatory changes were most prominent in insulin-treated rats.Conclusions: L-arginine and bromocriptine mesylate prevent early neoplastic changes almost equivalent to metformin at least partially via hepatic AMPK activation.

Histological Effect of Gemcitabine on the Liver and Kidney of Male Rat with and without Melatonin

Background: the aim of this study is to identify the toxic effect of gemcitabine on the kidney and liver tissues of rat and whether melatonin has any protective effect on these tissues.
 MATERIALS AND METHODS: 32 adults male Wistar rats were selected and divided into four groups. Group A was the control group that received normal saline. Group B received gemcitabine alone in a dose of 25mg/kg body weight intraperitoneally once per week for four successive weeks. Group C received gemcitabine intraperitoneally in a dose of 25mg/ kg and melatonin orally in a dose of 10mg/kg once per week for four successive weeks. Group D received only melatonin 10mg/kg once per week for four weeks.
 RESULTS: The histological changes of liver of group B showed disorganization of hepatic tissue with congestion in the portal area and chronic inflammatory cells infiltration in the periportal area. Nuclei of some hepatocytes were vesicular with steatosis. In group C liver sections showed inflammatory cell infiltration with mild pyknosis of some hepatocytes. Liver sections of group D were limited to degeneration of some hepatocyte. Renal sections of group B showed degeneration and necrosis of epithelial cells with thickening of blood vessel wall, congestion and thrombus formation with cystic appearance in the interstitial tissue were detected. While in group C the histological sections showed swelling of epithelial cells lining renal tubules with congestion of blood vessels. Renal sections of group D were more or less normal.
 CONCLUSION: the present study concluded that gemcitabine induced toxic effect on liver and kidney of male rats and melatonin may play protective effect on the tissue of these organs.
 Key wards: gemcitabine, melatonin, liver, kidney, rat

A unique case of inflammatory myofibroblastic tumor of the liver manifesting with biloma: A case report.

Anaplastic lymphoma kinase (ALK)-negative hepatic inflammatory myofibroblastic tumors (IMTs) harboring the ETS variant transcription factor 6-neurotrophic receptor tyrosine kinase 3 (ETV6-NTRK3) fusion gene and manifesting with biloma are extremely rare, and their biological behavior is unclear. The present study reports the case of a 45-year-old female with ALK-negative IMT of the liver harboring the ETV6-NTRK3 fusion gene and manifesting with biloma. Computed tomography of the abdomen confirmed the lesions to be a low-density mass, measuring 11.2×8.5×10.5 cm, located in the left lobe of the liver, and a lower-density mass, measuring 8.5×6.1×5.9 cm, located in the interior of the tumor. As the suspicion of a malignancy remained high, surgical resection of the left hepatic lobe, including the tumor, was undertaken. Intraoperatively, a tumor (12×10×9 cm), with an unclear boundary, incomplete capsule and fish-like texture, was found in the left lateral lobe of the liver, and a biloma, measuring 8×6 cm, was identified inside the tumor. Pathological examination revealed spindle cell proliferation with infiltration of chronic inflammatory cells and mucinous degeneration. Immunohistochemical studies showed negativity for ALK, CD117, CD34, discovered on GIST-1, desmin, smooth muscle actin, S-100, CD21, pan-cytokeratin, epithelial membrane antigen, CD23 and CD35, but positivity for vimentin staining, and 5% Ki-67-positive cells. Fluorescence in situ hybridization studies assessing characteristic genetic rearrangements using ALK, RET, ROS1, MDM2, MGEA5 and ETV6 break-apart assays, revealed the presence of the ETV6-NTRK3 fusion oncogene and negativity for ALK, RET, ROS1, MDM2 and MGEA5. The patient was discharged 7 days post-operatively, without any adjuvant treatment. No recurrence of symptoms was noted at the 3-year follow-up. To the best of our knowledge, this is the first report of biloma in an ALK-negative IMT of the liver, which may increase our understanding of hepatic IMT.

Effects of Chemical Composition of Cholesterol and Pigment Stones on the Gallbladder Mucosa

Objective: To compare the effect of chemical composition of cholesterol and pigment stones on gallbladder mucosa. Study design & setting: This comparative cross-sectional study was conducted in the Department of Anatomy, BMSI, JPMC, Karachi, Pakistan, from April to September 2021. Methodology: Total n= 120 gallbladder specimens were collected after cholecystectomies in 10% formalin. Gross morphological features of gallbladder and stones were observed. Specimens were processed and 5µm sections from fundus, body & neck of gallbladder were stained and examined for microscopic changes. Chemical analysis of stones was carried out to differentiate between cholesterol & pigment stones. Results: We evaluated different histomorphological alterations in gallbladder with reference to both type of gallstones. Muscular wall thickness in pigment stone group was noted to be (143.89±78.66) and in cholesterol group (158.37±83.95). Both pigment and cholesterol stone showed increased tendency of muscular hypertrophy. Mucosal ulceration, chronic inflammatory cell infiltration, capillary congestion and hyperplasia (p-value: 0.04) were observed in both type of stones. Statistical analysis showed that large cholesterol stones produce significant histopathological changes (p-value: 0.004); greater the size of stone, more profound was the mucosal hyperplasia. Rokitansky-Ashcoff sinuses were predominant in gallbladders with cholesterol stone. Conclusion: Gallstones cause series of histopathological changes ranging from chronic cholecystitis to pre-malignant and malignant changes. Hyperplasia was observed to be more frequent with long standing, large cholesterol stones

Preparation of polyclonal antibodies against chemically synthesized ApxIA and ApxIVA toxins and their diagnostic efficacy in the experimentally injected mice

ObjectivesApxIA and ApxIVA are the main virulence factors of Actinobacillus pleuropneumoniae (A. pleuropneumoniae). The preparation of their antibodies is of great significance for diagnosing and treating porcine pleuropneumonia. MethodsThis study used chemically synthesized ApxIA and ApxIVA peptides as immunogens to prepare polyclonal antibodies against ApxIA and ApxIVA. Their titers were determined by ELISA and Dot blotting. Histopathology of apparently infected organs was carried out. Finally, the immunofluorescence method detected the distribution of antigens in the visceral tissues of mice infected with ApxIA and ApxIVA toxins. ResultsThe results showed that ApxIA and ApxIVA polyclonal antibodies with titer as high as 1: 200000 and 1: 50000, respectively, were successfully obtained. The immunofluorescence results showed that these polyclonal antibodies could accurately detect ApxIA and ApxIVA antigens in mouse lungs with strong specificity. Histopathologically, there were perialveolar hemorrhages, pulmonary emphysema, and sloughing of bronchiolar epithelium. There was vacuolation and infiltration of chronic inflammatory cells in the liver parenchymal tissue. Atrophy of intestinal villi and glands and sloughing of villus epithelium, and congestion. There was increased urinary space and congestion in the proximal convoluted tubules. Lymphoid follicles increased in size in the spleen, the germinal center enlarged, and congestion in surrounding lymphoid tissue were observed. ConclusionThis study laid a foundation for the research and development of a rapid detection kit for A. pleuropneumoniae and provided conditions for diagnosing and treating porcine contagious pleuropneumonia.

Subungual melanoma with blue naevus-like morphological features: a clinicopathological retrospective analysis of nine cases

Melanocytic lesions in the nail apparatus are often challenging. Both subungual melanomas (SUM) and blue naevus of the nail are very rare. Occasionally, melanomas may mimic blue naevus histologically. Benign and malignant blue melanocytic lesions are commonly associated with G protein mutations, a distinct abnormality not associated with conventional subungual melanomas. We describe the clinical, histological and immunohistochemical features of nine cases of SUM with blue naevus-like morphological features. Mutations in exon 4 and 5 of GNAQ and GNA11 were investigated in two cases, which showed no mutations. RNA-seq of one case revealed unknown mutations along with mutations in ATM, METK and ARID1A. Our study delineates a variant of SUM that mimics blue naevus. Awareness of this pitfall is important when evaluating heavily pigmented lesions around the nail in order to avoid misdiagnosis. Appropriate sampling of subungual lesions and clinicopathological correlation are paramount to reach the correct diagnosis.

HISTO-AMELIORATIVE EFFECT OF PLEUROTUS TUBERREGIUM AGAINST LEAD INDUCED HEART, SPLEEN AND LOWER GUT DAMAGE IN ALBINO RAT

This study evaluates ameliorative effect of Pleurotus tuberregium on the effects of lead (Pb) using different concentrations of Pleurotus tuberregium /growers mash feed mixture in 90 Albino rats divided into six groups with three replicates (with 5 rats per group) for 21days pre-experimental stage for proper acclimatization. There after all the experimental groups were exposed to 0.1 g/l of lead daily for 21days. At the end of exposure period, lead salt was discontinued for 21and 42days post-experimental stage. Tissues of heart, spleen and lower gut were then collected and subsequently analyzed for the structural changes at every 21days interval. The tissues of the pre-experimental stages showed normal tissues as those of the control except in the lower gut which showed ileal mucosa with chronic inflammatory cell infiltration and muscularis propria. However, the experimental groups, showed observable damages to the tissues of heart (with transmural oedoma and myocardial degeneration, interstitial haemorrhage and coronary vascular hypertrophy), spleen(with focal activated follicles and sinus hyperplasia.) and lower gut (have ileal mucosa with focal atrophy and normal muscularis propria) which improved in the post experimental stages after 21 and 42 days with increased Pleurotus tuberregium content in the feed. The results of this study demonstrated that P .tuberregium may ameliorate lead toxicity in heart, spleen and lower gut tissues

Evaluation of Hepatoprotective Activity of Whole Fruit Extracts of Luffa Acutangula. Var. Amara and Rhizome Extracts of Rheum Emodi in CCl4 - Induced Chronic Hepatotoxicity

To investigate the hepatoprotective activity of whole fruit extracts of Luffa acutangula.var. amara and rhizome extracts of Rheum emodi in CCl4 treated rats. The dried powders of L. amara and R. emodi were extracted successively with petroleum ether, ethanol and distilled water. The hepatoprotective capacity of the extract of the whole fruits of L. amara and the rhizomes of R. emodi was analyzed in liver injured CCl4- treated male rats. The present study explored the possibilities of using low doses of both plant extracts (150mg/kg, and 300mg/kg bw, po route) to treat CCL4 intoxicated albino rats in both acute and chronic models of hepatic damage, evident by increased serum levels of glutamate pyruvate transaminase (SGPT), glutamate oxaloacetate transaminase (SGOT), alkaline phosphatase (ALP), direct bilirubin, total bilirubin, cholesterol and triglycerides, all being implicated in considerable hepatic damage.
 Histopathological examination in CCl4 treated rats revealed collapse of liver parenchyma with early fibrosis and chronic inflammatory cell infiltration in patchy areas around central vein (Pic.group-2) when compared to the control group. Histopathological and physical examinations also indicated their effectiveness with their dose tolerability and liver protection.
 Ethanolic and aqueous extracts of the whole fruits of L. amara and rhizomes of R. emodi were indicative of more hepatoprotective properties when compared to the petroleum ether extracts of both plants against CCl4 induced liver damage as confirmed from hepatic serum marker enzyme activities and histopathological studies.

An Immunohistochemical Assessment of Ki-67 and P53 Over-expression in Helicobacter pylori-positive Gastritis

AIM: Helicobacter pylori infection of the stomach is a common disease and the resulting changes from it are many and deserve to be in the focus of researchers’ attention, to assess the expression of mutant P53 protein and Ki-67 markers in patients with gastritis secondary to H. pylori. METHODS: Thirty samples with positive H. pylori gastritis were included in a retrospective study in Mosul/Iraq. The histological parameters were assessed using the Sydney system, then, the expression of Ki-67 and P53 expression was studied by immunohistochemical methods. The significance level was appointed at (0.05). RESULTS: Ki-67 and P53 expression were found in 83.3% of the total cases. The study results show that 92% of positive Ki-67 and P53 cases had chronic inflammatory cell infiltration, polymorph nuclear cells infiltration, and atrophy. Whereas 96% of positive Ki-67 cases had no metaplasia, 92% of the positive P53 cases had no metaplasia. The results also showed that only 16% of the positive Ki-67 cases had dysplastic changes, and 24% of the positive cases of P53 cases were showed dysplasia. whenever P53 was negative; there is neither metaplasia nor dysplasia in the tissue, this does not apply to Ki-67 negative cases. CONCLUSIONS: Ki-67 and P53 expressions increase with chronicity of Helicobacter pylori-positive gastritis. P53 expression is amplified when atrophy is present in these samples.

Renal cancer associated with Xp11.2 translocation/TFE3 gene fusion: Clinicopathological analysis of 13 cases

ObjectiveTo explore the clinicopathological characteristics, immunohistochemical phenotype, diagnosis and differential diagnosis of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion. MethodsThe clinical history, pathological morphology, immunohistochemical phenotype and related molecular test results of 13 cases of Xp11.2 translocation/TFE3 gene fusion-related renal cell carcinoma were retrospectively analyzed, and the relevant literature was reviewed. ResultsOf the 13 patients, 5 were males and 8 were females. The age of onset ranges from 8 to 73 years old, most of which were middle-aged and elderly patients. Among them, there were 3 cases of left kidney tumor and 10 cases of right kidney tumor. In the treatment method, 2 of the 13 patients underwent partial nephrectomy, and 11 underwent radical nephrectomy. Histopathological morphology showed papillary, nested, tubular and acinar structures. The cytoplasm was transparent or eosinophilic, and the interstitial fibrosis was accompanied by chronic inflammatory cell infiltration, hemosiderin deposition and foam cell aggregation. The immunohistochemical analysis of 13 patient specimens all expressed TFE3 antibody, and the expression intensity was strongly positive; gene FISH detection technology revealed the breakage and rearrangement of TFE3 gene in 12 assessable cases. One of thirteen patients had a metastasis at follow-up from 3 to 69 months. ConclusionsThis type of kidney cancer was a rare subtype. Because of its complex and changeable shape, it has a high degree of overlap with other kidney cancer subtypes, and the missed diagnosis rate and misdiagnosis rate are extremely high. The diagnosis is mainly based on pathomorphology and immunohistochemistry, TFE3 positive expression and TFE3 gene destruction and rearrangement.

Results of tympanoplasty in reference to the condition of middle ear mucosa and edge of perforation in safe chronic otitis media

<div class="Section1"><p><strong>Background: </strong>Chronic suppurative otitis media (CSOM) is an important and a highly prevalent disease of the middle ear and poses serious health problem worldwide especially in developing countries where large percentage of the population lack specialized medical care, suffer from malnutrition and live in poor hygienic environmental conditions. Aim of the study was to study the outcome of tympanoplasty in the light of character of edge of perforation and middle ear mucosa condition.</p><p><strong>Methods: </strong>This prospective study was conducted in 39 patients who underwent tympanoplasty in the department of ENT and head and neck surgery, Assam medical college and hospital, Dibrugarh between 1<sup>st</sup> June 2019 to 31<sup>st</sup> May 2020. Rim of perforated tympanic membrane and middle ear mucosa were sent for HPE. Three post-operatives follow up were done and surgical success was measured in terms of graft uptake and improvement in hearing.</p><p><strong>Results: </strong>Out of 39 cases, successful graft uptake was seen in 33 (84.62%) cases. Extension of migration of squamous epithelium in the undersurface of tympanic membrane was found in all 6 cases (3 had complete epidermosis while 3 had partial). All the six graft failure cases had diseased middle ear mucosa, mostly infected hypertrophied mucosa and tympanosclerosis with infiltration of chronic inflammatory cells and 1 patient had keratosis flakes with vascular stroma.</p><p><strong>Conclusions: </strong>Hypertrophic changes with inflammation of middle ear mucosa and epidermosis on the medial surface of tympanic membrane was found to have negative influence on the tympanoplasty outcome.</p></div>

A rare case of caries sicca right shoulder

Caries sicca is the classic dry form of tuberculosis of proximal humerus. Caries sicca is a fairly rare extrapulmonary presentation of bone tuberculosis. It accounts for 0.9 to 1.7 percent of all extrapulmonary tuberculosis cases. A 23-year-old female presented to the orthopaedics outpatient department with complaint of pain and restriction of shoulder movements for 6 months. The patient has no history of tuberculosis previously, but has a history of a family member suffering from pulmonary Koch. On clinical examination there was tenderness over the Greater tuberosity with restricted external rotation, abduction up to 30 degrees with further passive abduction being painful. There was marked wasting of deltoid and other muscles. Patient´s biopsy was taken for histopathology which showed normal morphology of bony trabeculae, fibromuscular and fatty tissue infiltration of chronic inflammatory cells and at places epithelioid granuloma with langhans giant cells and caseous necrosis which favor the diagnosis of tuberculosis. The patient was started on chemotherapy antitubercular drugs with intensive phase of 2 months and continuation phase of 7 months. During the treatment period the patients were followed up clinic radiologically and the satisfactory shoulder movements abduction up to 90 degrees achieved after 9 months and erythrocyte sedimentation rate (ESR) was considered as a prognostic factor for treatment.

Genotoxic and histopathological alterations in rats exposed to herbal liquors

The increase in consumption of herbal liquors in Nigeria is a cause for alarm. These are consumed with the mis-conception that they are without toxic effects. The aim of this study is to investigate the genotoxic and histopathological alterations in rats exposed to herbal liquors. Female rats were exposed to herbal liquors for 6 weeks. The histopathological and genotoxic evaluation were done to assess extent of damage. Pathological examination revealed incidences of aggregates chronic inflammatory cell infiltrates in the heart of Jedi treated group while the heart of the other groups had no abnormalities. The histologic sections of the kidney tissue revealed congested vessels while the lung showed reduction in air filled alveolar spaces with infiltration of alveoli and interstitium by aggregates of inflammatory cells indnadicating moderate to severe pulmonary inflammation. Histologic sections of lung tissue in rats treated with herbal liquors reveals congestion of pulmonary vessels and interstitial hemorrhages. Genotoxic evaluation of rat lymphocytes exposed to herbal liquors via comet assay shows that rats administered with the different herbal liquors developed significant (p < 0.05) as revealed in the % DNA in tail, % DNA in head, olive moment, tail length and tail moment which indicates the presence of DNA strand breaks and a marker for oxidative DNA damage. This result reveals that herbal liquors contain substances that produce reactive oxygen species that have pathological effect on certain organs as well as inducing DNA strand breaks that could compromise the integrity of the DNA which can lead to mutation.

Enterobacteriaceae opportunism isolated from Caspian Turtle Mauremys caspica (Gmelin, 1774) suffering from a fracture of the external shell, East of Al-Hammar Marshes, Iraq

Caspian Turtles Mauremys caspica (Gmelin, 1774) are classified as an endangered species on the IUCN red list, by a variety of dangers including hunting, deliberate killings and infectious diseases. The present report included the Opportunistic bacterial isolation which caused clinical signs on the M. caspica Turtles caught from the East Al-Hammar freshwater marshes, during summer 2017. It was suffering from a fracture of the external shell, tissue damage, bacterial growth and acute inflammation of the body tissues. The common clinical signs were external hemorrhage, histopathological changes revealed degeneration and necrosis in all organs associated with chronic inflammatory cell infiltration and Melanomacrophage cells were detected in all turtle tissues. The most common macroscopic lesions found on the skin of the turtle and ulcerative skin, the result in abscesses and dermatitis, regenerative changes on skin lesions and ulcerative deep necrotic and gangrenous changes in the turtle examined. Four different genera of family Enterobacteriaceae which identified by the VITEK II system, with a probability level of 94-99%, Citrobacter freundii (29.06%), Klebsiella oxytoca (25.58%), Serratia fonticola (24.41%) and Enterobacter cloacae (20.41%). The result showed that of a total of sixty-five bacterial isolates from the necrotic lesions skin tissue, some of them which are considered a potential threat to the public health.

A case of nodular episcleritis mimicking a solitary giant episcleral mass.

To describe an atypical nodular episcleritis mimicking a solitary giant episcleral mass, which is not attributed to any systemic diseases and identified only after immunohistochemical examination. A sixty-year-old Chinese woman with systemic hypertension presented with 6-month history of giant, solitary and redness epibulbar mass arising from the superior aspect of her left eye. The lesion gradually enlarged, even with 6-month history of irregular topical steroid eye drops treatment. Imaging studies and laboratory test revealed a 10 mm × 8 mm episcleral mass absence of any infection indicator and autoimmune antibody changes. The mass was completely removed before its extension through the deep scleral, histopathologic examination revealed a nodular episcleritis composed of various chronic inflammatory cells infiltration. Topical steroid eye drops treatment combined with oral steroidal anti-inflammatory drugs was then administrated regularly for 1 month, and no recurrence occurred after 1-year follow-up. Nodular anterior episcleritis is characterized by underlying chronic inflammation of the anterior episclera and can be presented as asymptomatic episcleral mass. Besides a thorough investigation systemically, tissue biopsy is required for definite diagnosis.

IgG4-related hepatic inflammatory pseudotumor mimicking cholangiolocellular carcinoma

Inflammatory pseudotumor (IPT) is a benign tumor mass composed of chronic infiltration of inflammatory cells and fibrous tissue. IgG4-RD (related disease) in the hepatobiliary system has been widely recognized and includes IgG4-related hepatic IPT. This report describes a patient with IgG4-related hepatic IPT with sclerosing cholangitis. A 75-year-old woman was admitted to our hospital for the treatment of rectal cancer. Abdominal contrast-enhanced computed tomography revealed a low-density mass, 2.5cm in diameter, in the left lateral lobe. Magnetic resonance imaging showed that the mass was slightly hypointense on T1-weighted images and slightly hyperintense on T2-weighted images. Based on these results, we made a diagnosis of cholangiolocellular carcinoma, and we performed a left hepatectomy. Histopathological examination showed that the mass was composed of fibrous stroma with dense lymphoplasmacytic infiltration. Immunohistochemically, IgG4-positive plasma cells were observed. The final diagnosis was IgG4-related hepatic IPT with sclerosing cholangitis. IgG4-related IPT is a relatively rare disease that can occur in any organ of the body. Although the accurate diagnosis of IgG4-related hepatic IPT remains difficult, IgG4-RD should be included in the differential diagnosis of liver tumors and histological analysis performed.

Targeting Leukocyte Trafficking in Inflammatory Bowel Disease.

In the last two decades, understanding of inflammatory bowel disease (IBD) immunopathogenesis has expanded considerably. Histopathological examination of the intestinal mucosa in IBD demonstrates the presence of a chronic inflammatory cell infiltrate. Research has focused on identifying mechanisms of immune cell trafficking to the gastrointestinal tract that may represent effective gut-selective targets for IBD therapy whilst avoiding systemic immunosuppression that may be associated with off-target adverse effects such as infection and malignancy. Integrins are cell surface receptors that can bind to cellular adhesion molecules to mediate both leukocyte homing and retention. In 2014, Vedolizumab (Entyvio®) was the first anti-integrin (anti-α4ß7 monoclonal antibody) treatment to be approved for use in IBD. Several other anti-integrin therapies are currently in advanced stages of development, including novel orally administered small-molecule drugs. Drugs targeting alternative trafficking mechanisms such as mucosal addressin cellular adhesion molecule-1 and sphingosine-1-phosphate receptors are also being evaluated. Here, we summarise key established and emerging therapies targeting leukocyte trafficking that may play an important role in realising the goal of stratified precision medicine in IBD care.