Common Pathological Finding Research Articles

S2884 Infliximab - A Viable Treatment for Autoimmune Enteropathy

INTRODUCTION: Autoimmune Enteropathy (AIE) is a rare condition without established treatment guidelines. Typical symptoms include intractable diarrhea unresponsive to dietary changes, malabsorption, and weight loss. Common pathological findings include villous atrophy, crypt apoptotic bodies, lack of intraepithelial lymphocytes, and loss of goblet and Paneth cells. Anti-enterocyte and anti-goblet cell antibodies are found in 60-100% and 40%, respectively. Corticosteroids are first line treatment followed by immunosuppressive therapy. Total parenteral nutrition (TPN) is required in severe malnutrition. We have a case demonstrating the role of TNF therapy in steroid refractory AIE. CASE DESCRIPTION/METHODS: This patient is a 46 year old man with hypertension, hyperlipidemia, and atopic dermatitis who presented with severe diarrhea following lumbar fusion surgery, endorsing 20-30 Bristol 7 bowel movements daily. He was on a pain control regimen but reported taking minimal NSAIDs. Patient was not on an angiotensin receptor blocker. He presented from his primary care provider after he was found to have a potassium of 2.0 mEq/L. His nutritional status and electrolyte abnormalities continued to deteriorate and TPN was initiated. An MR enterography was performed and found no structural abnormalities of the small bowel. He underwent endoscopic evaluation where biopsies were taken from the duodenum, jejunum, ileum, and colon. Pathology reports showed crypt apoptosis and loss of both goblet and Paneth cells diagnostic for AIE. The patient started a high-dose steroid regimen of 60 mg prednisone daily with no significant clinical response after two weeks of therapy. Infliximab was started at 10 mg/kg every 8 weeks following a loading dose of 10 mg/kg at weeks 0, 2, and 6. Since beginning infliximab, the patient has experienced an improvement in symptoms and is currently at his baseline of 1–2 bowel movements per day. DISCUSSION: AIE is a rare cause of intractable diarrhea. Incidence is estimated at less than 1 in 100,000. Treatment consists of steroids, immunosuppressive agents, and nutritional support. Immunosuppressants that have been studied include infliximab, adalimumab, vedolizumab, and tacrolimus. Our case demonstrates the utility of infliximab for induction of remission and maintenance therapy of Autoimmune Enteropathy.

Clinicopathological presentation of patients with prostate cancer at Muhimbili National Hospital in Dar es Salaam, Tanzania

Prostate cancer (PC) is the most common type of cancer in men and is of major public health importance worldwide. This study aimed to establish the clinicopathological presentation and its impression in disease progression like to Castrate Resistant Prostate Cancer (CRPC) of patients treated for Prostate Cancer at Muhimbili National Hospital (MNH) in Dar es Salaam.This was a retrospective descriptive hospital based study at Muhimbili National Hospital. Patients who were treated for prostate cancer were identified. Information regarding primary prostatic cancer treatment, clinical disease progression symptoms, and age of the patients were collected. A total of 293 case notes were reviewed of which 189 patients who were treated for prostatic carcinoma with androgen deprivation, 96(50.8%) met the criteria for the diagnoses of Castrate Resistant Prostate Cancer (CRPC) and their mean age was 71.23±4.2. About half of our patients 146(49.7%) presented with history of urine retention necessitating urethral catheterization but also patients had hard, nodulated, grade three prostate though 48.2% had missing documentation of Digital Rectal Examination (DRE) findings. Most of the patients had a poorly differentiated histology with PSA over 100ng/l. Almost all patients had a clinical progression signifying a metastatic disease. Majority of patients presented with symptomatic prostate cancer contrary to the natural history of prostate cancer at its early stage. Urine retention and hard nodulated grade three prostate were the commonest clinical presentation whereas poorly differentiated carcinoma of the prostate was a common pathological finding among patients with prostate cancer MNH in Dar es Salaam, Tanzania.

Pathophysiology and Pathology of Acute Kidney Injury in Patients With COVID-19.

Acute kidney injury (AKI) is common among hospitalized patients with Coronavirus Infectious Disease 2019 (COVID-19), with the occurrence of AKI ranging from 0.5% to 80%. The variability in the occurrence of AKI has been attributed to the difference in geographic locations, race/ethnicity, and severity of illness. AKI among hospitalized patients is associated with increased length of stay and in-hospital deaths. Even patients with AKI who survive to hospital discharge are at risk of developing chronic kidney disease or end-stage kidney disease. An improved knowledge of the pathophysiology of AKI in COVID-19 is crucial to mitigate and manage AKI and to improve the survival of patients who developed AKI during COVID-19. The goal of this article is to provide our current understanding of the etiology and the pathophysiology of AKI in the setting of COVID-19.

Sonography of Knee Effusion

Objective: A review of the anatomy of the synovial recesses of the knee is important to better understand the different effusion presentations, update the diagnosis criteria of knee effusion based on the measured synovial recesses and discuss the differentiation of some effused recesses from other lesions around the knee. Method: This review focuses on the anatomy of the synovial recesses of the knee and classifies them into three groups (anterior, parameniscal, and posterior recesses), as well as provides an overview on the etiology of knee effusion, its sonographic detection, and diagnosis criteria. Results: Knee effusion is a very common pathological finding in sonography of the knee. The unique joint structure of the knee provides the possibility to host complex synovial recesses. Fluid in some of the synovial recesses is valuable for the diagnosis of knee effusion, while in certain situations, some recesses may impose diagnostic uncertainty. Knowledge of these synovial recesses is essential to avoid diagnostic pitfalls. Conclusion: This review provides an important discussion of the differentiation of some recesses effusions from other lesions around the knee.

Clinical, pathological and virological aspects of fatal West Nile virus infections in ten free-ranging goshawks (Accipiter gentilis) in Germany.

West Nile virus (WNV), a zoonotic arbovirus, is a new epizootic disease in Germany and caused increasing avian and equine mortality since its first detection in 2018. The northern goshawk (Accipiter gentilis) is highly susceptible to fatal WNV disease and thus is considered as an indicator species for WNV emergence in European countries. Therefore, information regarding clinical presentation and pathological findings is important for identifying suspect cases and initiating further virological diagnostics. Between July and September 2019, ten free-ranging goshawks were admitted to the Small Animal Clinic of the Freie Universität Berlin with later confirmed WNV infection. Clinical, pathological and virological findings are summarized in this report. All birds were presented obtunded and in poor to cachectic body condition. Most of the birds were juveniles (8/10) and females (9/10). Neurologic abnormalities were observed in all birds and included stupor (3/10), seizures (3/10), head tremor (2/10), head tilt (2/10), ataxia (2/10) and monoplegia (2/10). Concurrent diseases like aerosacculitis/pneumonia (7/10), clinical infections with Eucoleus spp. and Trichomonas spp. (3/10), trauma-related injuries (3/10) and myiasis (2/10) were found. Blood analysis results were unspecific considering concurrent diseases. Median time of survival was two days. The most common pathological findings were meningoencephalitis (9/10), myocarditis (8/10), iridocyclitis (8/8) and myositis (7/10). WNV infection was diagnosed by real-time quantitative reverse transcription polymerase chain reaction and confirmed by serology and immunohistochemistry.

Incidence and Reconstruction of Chronic Radiation-Induced Chest Wall Ulceration in Postoperative Breast Cancer Patients

Background: Breast cancer patients who receive radiotherapy for postoperative tumor control are exposed to the possibility of adverse effects including osteoradionecrosis and ulceration. The purpose of this study is to explore reconstruction of ulcers according to their characteristics, and also to investigate the incidence of skin ulcers in patients who had undergone radiotherapy after modified radical mastectomy (MRM).Methods: Data of patients who underwent radiation therapy after MRM from 1979 to 2003 were collected. Demographics and radiation details were analyzed along with their reconstruction outcomes and pathologic characteristics. Effects of surgical debridement and reconstruction strategies for success were also assessed.Results: A total of 113 patients had radiotherapy after MRM in our institution, out of which nine patients (7.96%) developed ulcerations in the chest wall. Eleven patients underwent reconstructive surgery, including the nine patients who developed chest wall ulcerations and an additional two patients from other hospitals. Seven patients had thoracoepigastric flaps while three had latissimus dorsi musculocutaneous flaps and one had a perforator flap. The average initial wound size was 5.77 cm<sup>2</sup>, and this average was enlarged by 23.6 times after debridement. There was no reconstructive failure in any of the patients. Fibrosis, necrosis with ulceration, and dystrophic calcification were common pathological findings. Dystrophic calcification was found in seven of 11 cases. Additionally, ossification with bone formation was noted in three of seven cases with dystrophic calcification.Conclusion: A thorough preparation of the wound bed and reconstruction with flaps appropriate for the defect can successfully treat chronic radiation-induced ulceration.

ISOLATED MYOCARDIAL BRIDGING: A POTENTIAL CAUSE OF SUDDEN CARDIAC DEATH IN THAILAND

Introduction. The clinical significance of myocardial bridging (MB) as a potential cause of death has been debated. There is inconsistency in prevalence reports of MB as a cause of death in sudden cardiac death (SCD). We aimed to identify the prevalence of MB as a potential cause of SCD in non-ischemic heart disease (non-IHD) in Asian population. Methods. The SCD autopsy reports from Bangkok, Thailand between January 2012 and June 2014 were included. External causes, drug toxicity, and inconclusive autopsies were excluded. Conventional risk factors were recorded and compared between MB and non-MB. Results. Among 1,152 autopsy reports, 138 cases (85.5% male) were considered as SCD. 111 cases (80.4%) were caused by ischemic heart disease (IHD) whereas 27 cases (19.6%) were not (non-IHD). In IHD, the causes of death were coronary atherosclerosis, acute myocardial infarction, and old myocardial infarction (41.4, 34.2, and 24.3%). In non-IHD, MB was the most common pathological finding of SCD, followed by isolated left ventricular hypertrophy, hypertrophic cardiomyopathy, and myocarditis (29.6%, 25.9%, 22.2% and 14.8%). There were more males in both groups (MB [87.5%], non-MB [85.4%]). Mean (SD) heart weight of MB was lower than non-MB, [345.0(49.6) vs. 444.0(108.6) g, p=0.012]. There was no difference in mean age and body mass index. Conclusions. Our study suggested that MB might be a potential cause of SCD in non-IHD Asian population and highlights the mortality in asymptomatic MB patients.

Completion imaging techniques and their clinical role after carotid endarterectomy: Systematic review of the literature.

Completion imaging has been suggested for the intraoperative quality control assessment of the carotid endarterectomy technical success, in order to immediately resolve pathologic findings and accordingly improve patients' outcome. The aim of this study was to present existing evidence of different completion imaging techniques after carotid endarterectomy and their role on clinical outcome. A systematic review was performed searching in MEDLINE, CENTRAL, and Cochrane databases including studies reporting on completion imaging techniques after carotid endarterectomy. A total of 12,378 patients in 35 studies (20 retrospective and 15 prospective) underwent a completion imaging technique after carotid endarterectomy: in 19 studies, 5340 patients underwent arteriography; in 5 studies, 2095 angioscopy; in 21 studies, 5722 DUS; and in 2 studies, 150 patients underwent transcranial Doppler. Ten studies assessed > 1 imaging technique. The mean age was 67 ± 7 years old (69% males) with common co-morbidities to be hypertension (74%), smoking (64%), and hyperlipidemia (54%). Almost half of the patients (4949; 44%) were treated for symptomatic disease. In 1104 (9.7%) patients, a major defect was identified intra-operatively, while in 329 patients (2.9%), a minor defect. Common pathological findings were the presence of mural thrombus, carotid dissection, residual stenosis, and intimal flaps. An immediate re-intervention was undertaken in 75% (790/1053) of the patients to treat a major intra-operative imaging finding. In patients with re-intervention, only 2.3% (14/609) had an intra-operative stroke and 0.8% (5/609), a transient ischemic attack, while only 1.4% (8/575) had a stroke and 0.2% a transient ischemic attack (1/575) during 30-day post-operative period. No intra-operative death was reported. In the same period, the restenosis rate of internal and common carotid artery was 0.5% (3/575) and 0.2% (1/575), respectively. Completion imaging techniques can detect defects in almost 10% of patients that may lead to immediate intra-operative surgical revision with low intra-operative stroke/transient ischemic attack rate and low early carotid restenosis. During the 30-day follow-up period, in those patients, the incidence of stroke/transient ischemic attack may be low but present. This review cannot provide any evidence on which completion imaging technique is better, and the clinical impact conferred by each technique in the absence of a randomized control studies.

Assessment of diagnostic value of different methods (culture, PCR and biopsy) for the diagnosis of tuberculosis in patients with bronchial anthracosis

Introduction: Although several studies have shown the relationship between tuberculosis (TB) and anthracosis, few studies have investigated the diagnostic value of various methods of diagnosis of TB in these patients. Objectives: This study was conducted to investigate the diagnostic value of different methods including smear, culture and polymerase chain reaction (PCR) of bronchoalveolar lavage (BAL) sample and bronchial biopsy specimens in the diagnosis of TB in patients with bronchial anthracosis. Patients and Methods: This descriptive cross-sectional study was performed on 67 patients referring for bronchoscopy, and bronchial anthracosis was an incidental finding. The BAL sample and patients’ bronchial biopsies were examined for TB infection. Results: The most affected areas by anthracosis were the right and the left upper lobes. The BAL smear and its culture were positive in 12 (20%) and 10 patients (17%), respectively. The PCR of BAL sample was positive in 37%. Non-specific chronic inflammation followed by bronchial anthracosis was the most common pathologic findings. According to pathological examinations, nine patients (13%) had TB. Sensitivity and specificity of the PCR versus culture were 90% and 70%, respectively, with a diagnostic accuracy of 74%. Sensitivity, specificity and diagnostic accuracy of the pathologic examination of biopsy specimen were 33%, 85% and 74%, respectively. Conclusion: Findings of this study showed that nearly one fifth of patients with bronchial anthracosis suffer from TB simultaneously. In these patients, PCR of the BAL and pathologic examination of the biopsy specimen had the same diagnostic accuracy, but the sensitivity of PCR was three times higher. However, application of PCR and pathologic examination does not seem to have more diagnostic advantages than BAL culture for the diagnosis of TB, although the results by PCR may help to diagnose the disease sooner.

Hard Metal Lung Disease: Update in Diagnosis and Management

Hard metal lung disease is a rare entity due to cobalt and tungsten carbide exposure. This review summarizes the literature focusing on pathogenesis, clinical features, diagnosis, and management. Theories for pathogenesis include immunogenic activation, oxidant injury, and induction of hypoxia-inducible factor in macrophages. Multinucleated giant cells with bizarre cannibalistic features are the most common pathological finding; however, it is not pathognomonic. Corticosteroids remain the mainstay of treatment based on data from small studies. Hard metal lung disease exposure can lead to an occupational asthma or parenchymal lung disease, potentially leading to respiratory failure. A history of exposure and clinical findings along with appropriate radiographic and pathological findings are essential to establish a diagnosis. Treatment options include exposure cessation, corticosteroids, immunosuppressive therapies, and lung transplantation.

Surgical treatment of intraspinal tumors in Southern Taiwan: The 30-year experience of a single institution

Our institute presented two reports of intraspinal tumors, one in 1997 and the other in 2007, which assessed 120 and 117 cases of diagnosed and surgically treated intraspinal tumors at Kaohsiung Medical University Hospital, Southern Taiwan during 1988–1995 and 1999–2004, respectively. Here, we analyze data from 247 patients with medical records indicating surgery for and pathological reports of intraspinal tumors at the same institute during 2004–2014. Correlational findings from this study were compared with those from the previous two reports. There were 123 male and 124 female patients aged 7–93 (mean age: 55.4) years. The most common pathologic findings were metastasis (50.6%, 125/247), followed by nerve sheath tumors (30.8%, 76/247), meningiomas (6.0%, 15/247), and neuroepithelial tumors (5.2%, 13/247). A slight male predominance in metastasis and a slight female predominate in meningiomas were noted. The peak ages at diagnosis were 51–60 years. Motor weakness was the most common clinical presentation (46.1%). The thoracic spine segment was the most common location (51.4%, 127/247), followed by the lumbosacral (25.5%, 63/247) and cervical (23.1%, 57/247) spine segments. Among the metastatic tumors, the lung was the most common primary site of origin, followed by the liver (hepatocellular carcinoma), lymphoma, prostate, GI (gastrointestinal) tract, breast, and nasopharynx (nasopharyngeal cancer).

Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0\xa0T MRI

ObjectiveTo identify abnormalities in asymptomatic sedentary individuals using 3.0 Tesla high-resolution MRI.Materials and methodsThe cohort comprised of 230 knees of 115 uninjured sedentary adults (51 males, 64 females; median age: 44 years). All participants had bilateral knee 3.0 T MRIs. Two senior musculoskeletal radiologists graded all intraarticular knee structures using validated scoring systems. Participants completed Knee Injury and Osteoarthritis Outcome Score questionnaires at the time of the MRI scan.ResultsMRI showed abnormalities in the majority (97%) of knees. Thirty percent knees had meniscal tears: horizontal (23%), complex (3%), vertical (2%), radial (2%) and bucket handle (1%). Cartilage and bone marrow abnormalities were prevalent at the patellofemoral joint (57% knees and 48% knees, respectively). Moderate and severe cartilage lesions were common, in 19% and 31% knees, respectively, while moderate and severe bone marrow oedema in 19% and 31% knees, respectively. Moderate-intensity lesion in tendons was found in 21% knees and high-grade tendonitis in 6% knees—the patellar (11% and 2%, respectively) and quadriceps (7% and 2%, respectively) tendons being most affected. Three percent partial ligamentous ruptures were found, especially of the anterior cruciate ligament (2%).ConclusionNearly all knees of asymptomatic adults showed abnormalities in at least one knee structure on MRI. Meniscal tears, cartilage and bone marrow lesions of the patellofemoral joint were the most common pathological findings. Bucket handle and complex meniscal tears were reported for the first time in asymptomatic knees.

MOG encephalomyelitis: distinct clinical, MRI and CSF features in patients with longitudinal extensive transverse myelitis as first clinical presentation

BackgroundBased on clinical, immunological and histopathological evidence, MOG-IgG-associated encephalomyelitis (MOG-EM) has emerged as a distinct disease entity different from multiple sclerosis (MS) and aquaporin-4-antibody-positive neuromyelitis optica spectrum disorder (NMOSD). MOG-EM is associated with a broader clinical phenotype including optic neuritis, myelitis, brainstem lesions and acute disseminated encephalomyelitis with a substantial clinical and radiological overlap to other demyelinating CNS disorders.ObjectiveTo evaluate common clinical, MRI and CSF findings, as well as therapy responses in patients with longitudinal extensive transverse myelitis (LETM) as initial clinical presentation of MOG-EM.MethodsAfter excluding patients with a known diagnosis of MS, we identified 153 patients with myelitis of which 7 fulfilled the inclusion criteria and were investigated for MRI, CSF and clinical parameters.ResultsPatients with LETM as first clinical presentation of MOG-EM display similar characteristics, namely a lack of gadolinium-enhancement in spinal cord MRI, marked pleocytosis, negative oligoclonal bands, a previous history of infections/vaccinations and response to antibody-depleting treatments for acute attacks and long-term treatment.ConclusionsWe identify common pathological findings in patients with LETM as first clinical presentation of MOG-EM which distinguishes it from other forms of LETM and should lead to testing for MOG-IgG in these cases.

Clinical, morphologic and histological features of chronic pyelonephritis: An 8-year review.

Urinary tract infection (UTI), especially pyelonephritis when inadequately treated may culminate in end-stage renal disease. The study aims to evaluate the risk factors for and clinico-pathologic features of chronic pyelonephritis (CPN) among patients in Aminu Kano Teaching Hospital, Kano, in North-Western Nigeria. Data on cases diagnosed as CPN between 2010 and 2017 in the study centre were retrieved from archives and analysed for risk factors and clinic-pathologic features. Forty-three cases of CPN were diagnosed in the study period and comprised 24 males and 19 females, with a male: female ratio of 1.3:1. The ages ranged from 3 to 80 years with a mean age of 37.0 ± 19.6 years. Urinary tract obstruction, poorly treated UTI, HIV infection and polycystic kidney disease were the risk factors in 21 (49%), 15 (35%), 6 (14%) and 1 (2%) cases, respectively. Proteinuria was seen in 10 (23.3%) of the patients, hypertension in 7 (16.3%) and haematuria in 3 (7.0%) of cases. Nephrectomy was done in 17 (39.5%) of the 43 CPN cases, indications for surgery were pus-filled, non-functioning kidneys. The diameters of the removed kidneys ranged from 10 to 28 cm and they weighed between 140 g and 2500 g. Scarring, reported in 79.0% of patients, was the most common pathological finding, followed by pus casts in 48.8% and focal segmental glomerulosclerosis in 27.9%. No statistically significant difference was found between age or gender and aetiology or risk factors of the disease (P > 0.05). CPN with pus-filled and non-functioning kidneys is a common indication for nephrectomy. Urinary tract obstruction, poorly treated UTI, and HIV infection were major risk factors seen in this environment. To prevent this complication there is a need for better training of clinicians in the diagnosis and adequate treatment of UTI.

Nephrotoxicity of Antimicrobials and Antibiotics.

Medication-induced nephrotoxicity remains one of the most common causes of acute kidney injury (AKI) among hospitalized patients. Within the extensive group of medications associated with AKI, antibiotics and other antimicrobials are well recognized triggers of structural and functional renal impairment. Clinical manifestations range from mild forms of tubular injury to significant deterioration of kidney function requiring acute renal replacement therapy. Several mechanisms are described, although the most frequent are acute interstitial nephritis, acute tubular necrosis, intratubular crystal deposition, and proximal/distal tubulopathy with electrolyte wasting abnormalities. General risk factors for antimicrobial-induced AKI include pre-existing chronic kidney disease, and concomitant use of medication with nephrotoxic potential. Prevention and early recognition of AKI represent the standard approach to mitigate AKI and avoid morbidity.

THE RELATIONSHIP OF NT PRO BNP AND ECHOCARDIOGRAPHIC FEATURES OF RIGHT VENTRICLE DISFUNCTION WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AT HAJI ADAM MALIK GENERAL HOSPITAL MEDAN

Background: Cardiovascular complications caused by Chronic Obstructive Pulmonary Disease (COPD) will affect structure and function of heart’s normal anatomy. This study aims to determine the relationship between the abnormality of NT Pro BNP levels and echocardiographic features of right ventricular (RV) dysfunction in COPD. Method: A cross-sectional study to assess the association between the abnormality of NT Pro BNP levels and echocardiographic features of right ventricular dysfunction in COPD in the outpatient unit of the Integrated Heart Center H. Adam Malik Hospital Medan. COPD patients were grouped based on GOLD criteria from spirometry examination into severe COPD (GOLD III) and very severe COPD (GOLD IV). Subjects then performed NT pro BNP and echocardiography examination to assess pathological changes in cardiac. Result: NT Pro BNP was higher in GOLD IV. Cut off value of NT Pro BNP > 172 pg/nl is the initial parameter of right ventricular dysfunction. Pulmonary hypertension was found in 93% of cases. The most common cardiac pathological findings were RV hypertrophy (71%), RV dysfunction (86.7%) and pulmonary regurgitation (87.5%). Pathological findings on echocardiography were more common in the GOLD IV group. COPD severity was associated with NT Pro BNP abnormalities (p <0.001) and associated with pathologic echocardiographic findings (p <0.001). Conclusion: Severe COPD is associated with increased NT pro-BNP abnormalities and pathological findings on echocardiography. Echocardiography facilitates early detection of cardiovascular complications in patients with severe and very severe COPD (GOLD III and IV).

Histopathology of Chronic Kidney Disease after Allogeneic Hematopoietic Cell Transplantation: A Multi-Center Observational Study of Kidney Biopsies

Background Renal dysfunction is a common complication of allogeneic hematopoietic cell transplantation (Allo-HCT) with proven negative impact on early and long-term mortality. The cumulative incidence of chronic kidney disease(CKD) after Allo- HCT varies from 13~60% in adult studies to as high as 62% in children. So far, most knowledge on chronic renal impairment in the context of Allo-HCT is based on clinical and laboratory findings. Causes of CKD are diverse, usually overlapping, and poorly understood. Kidney biopsies are performed in less than 5% patients with CKD, the pathophysiology of idiopathic CKD remains obscure. We conducted a multi-center clinicopathologic study of Allo-HCT patients with CKD to described the histopathologic spectrum of renal manifestations. Methods and Results Between 2005 and 2018, 24 recipients(17 males and 7 females) of Allo-HCT underwent kidney biopsy for either proteinuria or deterioration of kidney function at four centers. The median age was 43.8 (7.2~54.3) years, and the median time from Allo-HCT to kidney biopsy was 17.2(2.0~74.6)months. Evidence for GVHD was found in 20 (83.3%) patients. Among the 24 patients, 10 patients had a large amount of proteinuria (24-hour urine protein > 3.5 g/L), and 12 patients had elevated serum creatinine (Scr >110μmol/l). The most common pathological findings of kidney biopsy were GVHD (n=8), membranous nephropathy (MN, n=5), thrombotic microangiopathy (TMA, n=4), BK virus nephropathy (n=2), and we also found ischemic nephropathy, chronic interstitial nephritis, minimal change disease (MCD), GVHD with TMA, MN with focal segmental glomerular sclerosis (FSGS), MCD with acute tubular injury, BK virus nephropathy combined with calcineurin inhibitor nephrotoxicity in one case. The follow-up data showed 3 died of recurrent malignancy, 6 loss to follow-up , the median follow-up time was 18.3(12.3~120.2)months. Of the 18 patients, 8 (44.4%) had an estimated glomerular filtration rate (eGFR) of less than 60 ml/(min1.73m2), 5 (27.8%) still had moderate proteinuria. Conclusions A wide spectrum of renal pathologic findings can be observed in Allo-HCT patients. Either severe proteinuria or elevated serum creatinine were common presentations in this unique setting, which can be due to GVHD , MN, TMA, BK virus nephropathy , MCD, FSGS, and overlapping lesions. Kidney biopsies are necessary to establish the underlying cause of CKD in Allo-HCT patients. Disclosures No relevant conflicts of interest to declare.

TRACHEOBRONCHIAL MELANOSIS

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: “Black bronchoscopy,” i.e., black pigmentation seen in the tracheobronchial tree, may be caused by a variety of conditions, some of which are uncommon or rare. We present a case of tracheobronchial melanosis, an uncommon cause of black bronchoscopy, in an elderly woman. CASE PRESENTATION: A 78-year-old female with past history of squamous cell carcinoma of the lung status post radiation treatment and chronic obstructive pulmonary disease was admitted for pneumonia. X-ray and computed tomography of the chest (Figure 1) were consistent with bilateral pneumonia. Flexible bronchoscopy (Figure 2) showed extrinsic compressions of the bilateral bronchial tree, non-inflamed bronchial mucosa, and numerous melanotic areas with indistinct margins distal to secondary and tertiary carinas, consistent with tracheobronchial melanosis. Bronchoalveolar lavage specimens were negative for malignant cells or bacterial, fungal, mycobacterial, or viral pathogens. DISCUSSION: The main differential diagnoses for black bronchoscopy include tracheobronchial melanosis, endobronchial pigment-producing infections, healed endobronchial tuberculosis, melanoma and other neoplasms, carbon, silica or silver exposure, burn injury, amiodarone, charcoal aspiration, and thermal ablation of endobronchial lesions. While not common, tracheobronchial melanosis is typically seen as an incidental finding on bronchoscopy. The lesions consist of areas of black pigmentation with indistinct margins, mostly adjacent to secondary and tertiary carinas [1]. Tracheobronchial melanosis is usually discovered in the absence of other mucosal abnormalities, and its clinical significance has not been determined. However, it is mostly considered to be a benign congenital variant resulting from abnormal production of melanin pigments in the tracheobronchial mucosa [2]. CONCLUSIONS: In addition to understanding common pathologic and normal bronchoscopy findings, it is important for pulmonologists, especially those in training, to be familiar with uncommon findings, normal variants, and lesions with unknown clinical significance, such as tracheobronchial melanosis. Reference #1: Tunsupon, P, Panchabhai TS, Khemasuwan D, Mehta A. Black bronchoscopy. CHEST 2013; 144 (5): 1696-1706. Reference #2: Pagliaccio L, Mehta AC. Endobronchial melanosis: occurrence and possible significance [abstract]. CHEST 1989; 96: 222S. DISCLOSURES: No relevant relationships by Elizabeth Nielsen, source=Web Response No relevant relationships by Thamer Sartawi, source=Web Response No relevant relationships by Keivan Shalileh, source=Web Response no disclosure on file for Rajagopal Sreedhar

Equine Back Disorders: A comparative study between palpation and radiographic findings

The reason for performing this study was to investigate relationship between presence or absence of clinical signs of back problems with radiological findings and also to determine the prevalence of concurrent osseous pathology. Forty-four horses underwent clinical and radiological investigation of thoracolumbar spine. Results were recorded. Statistical analysis was performed to determine relationships between age, gender, work discipline, clinical and radiological features. The most common pathological finding was kissing spines syndrome. There was significant association between age, gender and work discipline and prevalence of pathological and radiological findings. X-rays revealed that horses with clinical signs of back problems were more likely to have osseous changes. Radiological examination should be always critically interpreted in a connection to the clinical sings in order to establish a diagnosis of a patient.

Renal pathology and clinical associations in systemic sclerosis: a historical cohort study.

BackgroundThe information guiding the treatment decision(s) for renal diseases in systemic sclerosis (SSc) is the renal pathological finding. This study aimed to evaluate the renal pathological diagnosis and its clinical feature among SSc.MethodA historical cohort study was performed on adult Thai SSc patients who underwent renal biopsy during January 2005–December 2016. The renal pathologic findings and patient clinical characteristics were reviewed. Chi-square or Fisher’s exact test was applied to analyze the association between clinical manifestation and renal pathology.ResultsOf the 26 SSc patients identified (77% female), 46% had the diffuse cutaneous SSc subtype. The mean age at the time of biopsy was 53.2±14.4 years and median duration of disease was 2.4 years (IQR 0.5–7.0). Rapidly progressive glomerulonephritis (RPGN) was the most common renal manifestation (53.9%) followed by nephrotic syndrome (19.2%) and nephritis (11.5%). The pathological diagnosis included lupus nephritis (LN) class IV (26.9%), LN class V (19.2%), scleroderma renal crisis (SRC; 19.3%), progressive renal disease in scleroderma (7.7%), and IgA nephropathy (7.7%). The nephrotic syndrome was the most common renal feature among LN class V patients, whereas RPGN was the commonest renal presentation among LN class IV and SRC patients (p=0.001). Dialysis treatment at the time of kidney biopsy was significantly higher in SRC patients than in the other groups (p<0.001). The SRC tended to have more frequent cardiac involvement, pulmonary fibrosis, and shorter disease duration than the other groups.ConclusionThis is the first report of renal pathologic findings in Thai SSc patients. RPGN is the commonest renal manifestation among SSc who underwent kidney biopsy; for whom LN was the most common pathological finding. Nephrotic syndrome is a clinical feature of glomerular diseases other than renal involvement in SSc.