Florid Lesions Research Articles

A case of coexistent acute severe alcoholic and Q fever hepatitis: The useful contribution of repeated liver biopsies

Acute Q fever is a worldwide zoonotic infection due to C. burnetii that may be associated with hepatitis. Nonspecific clinical and biological manifestations may accompany liver involvement, including hepatomegaly and elevated liver biological tests. However, the presence of jaundice is rare. Therefore, making a diagnosis of Q fever hepatitis may be difficult in an afebrile patient with jaundice of recent onset, altered liver function tests, excessive alcohol intake and no reported contact with animals. We report here the diagnostic work-up and complex clinical management of a patient presenting with acute hepatitis resulting from both C. burnetii infection and severe alcoholic steatohepatitis. Positive serology together with a detailed examination of the liver biopsy was able to reveal the coexistence of both Q fever hepatitis with typical fibrin-ring granulomas as well as florid lesions of alcoholic steatohepatitis. A combination of antibiotics, hydroxychloroquine and steroids, guided by the helpful description of changes in histological alterations on repeated liver biopsies during the course of the disease contributed to the slow but favorable outcome.

Nutritional Deficiency Dermatosis with Streptococcal Sepsis in an Aboriginal Child: a Case Report

A 7-month-old baby boy succumbed to death with a history of static weight gain since 4 months of age. Autopsy revealed florid skin lesions, evidence of malnutrition, pneumonia, and meningitis. Further testing isolated Streptococcus pyogenes in the blood culture. The skin lesions are highly likely due to the dermatosis in kwashiorkor and acquired zinc deficiency, complicated with bacterial infection and overgrowth of saprophytic fungal yeast cells.

Neuroendocrine Tumors of the Breast.

A small but increasingly recognized and studied subset of breast carcinomas are characterized by neuroendocrine (NE) differentiation. As with nearly all forms of breast neoplasia, NE tumors are characterized by considerable heterogeneity in microscopic appearance and clinical aggressiveness. About half of NE breast carcinomas recapitulate the histological spectrum typical of their counterparts in other organ systems, varying from "carcinoid-like" to small cell carcinoma, with most representing intermediate grade tumors. Despite NE morphology, these tumors have a high frequency of estrogen receptor expression. Clinical outcomes of women with NE breast carcinomas are reliably grade and stage dependent. Tumors associated with "solid papillary" differentiation comprise the remaining cases of NE breast neoplasia. Solid papillary carcinoma is an intrinsically low grade/favorable prognosis class of breast neoplasia that usually presents in post-menopausal age groups. About half of solid papillary carcinoma present as a distinctive pattern of ductal carcinoma in situ that may be difficult to recognize owing to its close resemblance to florid proliferative lesions. Invasive solid papillary carcinomas are characterized by a variety of histological patterns and often show mucinous differentiation. Future studies are necessary to better define the histogenesis, optimal classification, and improved directed therapies for NE breast neoplasia.

A Case Series of 130 Neonates with Congenital Syphilis: Preterm Neonates Had More Clinical Evidences of Infection than Term Neonates

Background: The early clinical manifestations of congenital syphilis (CS) vary from asymptomatic to florid lesions, involving multisystem damage. But little is known about the differences of early clinical features between preterm and term neonates with CS. Objectives: To compare the clinical characteristics between preterm and term neonates with CS and analyze the possible underlying reasons for the differences. Methods: Consecutive medical charts of infants at risk for CS from January 1999 to December 2009 were retrospectively reviewed. Neonates with positive 19S-IgM in serum were included in the study. Results: Among the 1,670 cases at risk for CS, 130 neonatal cases with positive 19S-IgM in serum were included in the analysis, including 58 preterm ones and 72 full-term ones. Compared with term neonates with CS, preterm ones were more likely to have characteristic skin rash (36.2 vs. 9.7%, p < 0.001), hepatomegaly (51.7 vs. 25%, p = 0.02), splenomegaly (32.8 vs. 15.4%, p = 0.02), PRP titer ≥1:8 (96.6 vs. 70.8%, p < 0.001), thrombocytopenia (43.1 vs. 23.6%, p = 0.018), elevated CRP (65.5 vs. 36.5%, p = 0.002), and abnormal long bone X-ray results (94.6 vs. 68.1%, p < 0.001). Fewer mothers of preterm neonates with CS received treatment for syphilis (15.5 vs. 40.3%, p = 0.003). The rate of withdrawal of care was higher in preterm neonates with CS (31 vs.12.5%, p = 0.036). Conclusions: Preterm neonates with CS had more clinical evidences and suffered more than term ones.

C2 Penile intraepithelial neoplasia: important lessons from a case series

BackgroundBASHH Guidelines recommend a biopsy to exclude premalignant conditions in persistent balanitis. PIN is a well recognised condition that can be difficult to identify. In UK GUM clinics, the incidence of reporting of PIN is rare compared to international studies raising the possibility of under-diagnosis. Locally, our clinic guidelines and policies have changed in line with BASHH guidance.AimsWe describe the clinical presentation, diagnostic process and management of PIN cases presenting to the sexual health clinic.ResultsFive cases were identified from August 2010 to March 2011. The median age was 38 years (range 31–52). 1/5 was an HIV infected MSM. Duration of symptoms ranged from 3 months to 18 years. 3/5 were initially managed inappropriately; having a delayed biopsy. In each case the condition manifested differently; with clinical appearances ranging from solitary hypertrophic lesions to multiple verrucous and leukoplakic lesions. The HIV positive patient had the most atypical and florid lesions. All of the men were uncircumcised; 2/5 were current smokers and 2/5 were previous smokers. One case had possible previous exposure to agricultural chemicals. Histologically: all biopsies had evidence of HPV infection, 4/5 had PIN3 and 1 had PIN1. 2/5 also had anal intraepithelial neoplasia; 1 presented to the surgeons with an anal lesion, but his penile lesion was missed. All were referred to local urology and three were reviewed further at a tertiary centre. 1/5 was treated with topical imiquimod only, 2/5 were treated initially with topical imiquimod then subsequent surgery with resolution of lesions and two had a surgical intervention as first line treatment.DiscussionMen presenting with atypical penile lesions should have a penile biopsy in line with BASHH guidance and a high index of suspicion for other genital dysplastic conditions, for example, AIN and clear local pathways for referral should be in place.

Positron emission tomography as a tool for the 'tailored' management of retroperitoneal fibrosis: a nephro-urological experience

Retroperitoneal fibrosis (RF) is a complex clinical entity characterized by a fibro-inflammatory reaction around the abdominal aorta and iliac arteries extended into the retroperitoneum. No biochemical marker correlates with the disease severity and progression, and imaging data fail to discriminate between fibrotic and florid lesions. Positron emission tomography (PET) was recently suggested as a promising tool to detect the disease. We report on seven consecutive cases of RF managed by tailoring therapeutic interventions to the metabolic activity detected by PET. In 2006-09, seven patients with RF (five new diagnoses) were referred to the same nephro-urological facility. There were six males and one female aged 41-79. RF was associated with autoimmune diseases in three patients, with an aortic aneurysm in another three, and was 'idiopathic' in one. The diagnoses were made by imaging techniques [computed tomography (CT) or nuclear magnetic resonance (NMR)]; PET scan was performed in all patients in the same setting at referral and during follow-up. Patients were followed up with tailored interventions (medical therapy: tamoxifen, steroids, and immunosuppressors according to disease activity, side effects and tolerance). Six patients needed ureteral stenting for obstruction. PET imaging was used as a guide for the tapering of immunosuppressors and for stent removal. In this way, stents were safely removed when a negativization of disease activity was revealed by PET. Only one relapse was recorded over 163 months of follow-up (median 24 months) detected in time by PET. PET is a promising tool for surveillance of disease activity and for planning the removal of ureteral stents in RF.

Is there a neuropathology difference between mild cognitive impairment and dementia?

The number of studies that have investigated the neuropathology of mild cognitive impairment (MCI) is small, but growing. In this paper we have restricted our focus to the consideration of the presence and extent of postmortem findings relevant to the neuropathology of Alzheimer's disease. We have drawn from studies that have investigated the postmortem neurobiology of the brains of persons with cognitive function at the interface between unimpaired normal function and mild but definite dementia. The data derived from these studies suggest that i) the brains of persons with MCI evidence significant neuropathological and neurobiological changes relative to those without cognitive impairment; ii) in general, the neuropathological and neurobiological changes are qualitatively similar to those observed in the brains of persons with frank AD-like dementia; and iii) the neuropathological and neurobiological brain changes associated with MCI are quantitatively less than those of persons who meet criteria for dementia. Thus, the available, albeit limited, data suggests that MCI is associated with the early stages of the neurobiological and neuropathological changes that culminate in the florid lesions of AD; including the accumulation of neuritic plaques, neurofibrillary tangles, synaptic and neurotransmitter associated deficits, and significant neuronal cell death.

Proactive therapy of atopic dermatitis – an emerging concept

Proactive therapy of atopic dermatitis – an emerging concept

African Kaposi Sarcoma – Florid Lesions in a Nigerian Male in South Eastern Equatorial Rain Forest: A Case Report.

Endemic African Kaposi sarcoma is a clinically and epidemiologically distinct human immunodeficiency virus negative form of Kaposi sarcoma (KS) occurring in Africa. This condition runs a variable clinical course ranging from minimal-florid cutaneous disease to extensive organ involvement. We present this seronegetive patient with peculiar and striking florid chemo-sensitive cutaneous lesions with good response in patient performance post chemotherapy. Kaposi sarcoma is chemo-sensitive and should be offered to patients as cutaneous KS lesions may be disfiguring and often generate significant psychological distress. Nigerian Medical Practitioner Vol. 50 (3&4) 2006: pp. 72-76

FURUNCULAR CUTANEOUS MYIASIS CAUSED BY DERMATOBIA HOMINIS LARVAE EOLLOWING TRAVEL TO BRAZIL

A 62‐year‐old Japanese man had visited Rondonia in central Brazii on May 28, 1994, at which time he suffered insect bites on the left axiila and ieft chest regions. Three bites persisted and became tender and painfui. These areas developed into tender nodules with moderate serous drainage from a central pore. Malaise and an intermediate‐grade fever accompanied the eruption. The tender nodules continued after he returned to Japan on July 7. The diagnosis of furunculosis was made by his family physician, but treatment with oral cefdinir (300 mg per day) and naproxen (600 mg per day) for 2 days and application of ointment containing 0.1% gentamicin sulfate failed to resolve the lesions. The patient complained of a crawling sensation under the skin. Since a maggot was removed from the axillary lesion with the aid of the patient's fingers, he was referred to the Dermatology Clinic of the Kurume University Hospital on August 1, for evaluation of parasitic diseases.Physical examination revealed two firm furuncle‐like erythematous nodules, 2.0 cm in diameter, with a centrally placed 4 mm punctum on the left side of the chest (Fig. 1). There was serous drainage from each punctum and a motile larva was seen in each cavity. A lesion on the axilla had healed spontaneously. Laboratory tests were normal. Two florid lesions on the chest were surgically removed under local anesthesia with 0.5% lidocaine hydrochloride. Histologic examination revealed a mixed cell inflammatory infiltrate throughout the dermis with a tract containing a larva. Examination of the larva revealed a segmented ovoid organism, 1.5 × 0.5 cm in size (Fig. 2). The lesions healed completely within 2 weeks without further treatment. The larva removed by the patient was forwarded to the Department of Medical Zoology, Faculty of Medicine, Tokyo Medical and Dental University, and was identified as third instar larvae of Dermatobia hominis, the human botfly. The other two of the third instar larvae were transplanted under the skin of a rat and a mouse to obtain pupae or adults, but they failed to pupate and died.

Pseudoangiomatous Stromal Hyperplasia (PASH)

Pseudoangiomatous stromal hyperplasia (PASH) is frequently a microscopic incidental finding in breast biopsies performed for benign or malignant disease. However, it may also produce a mass lesion. We reviewed PASH seen first as a tumor in 40 women aged 14 to 67 years (mean, 37 years). All but one lesion were clinically palpable. The exceptional tumor was found by mammography. The mass, typically unilateral, was usually diagnosed clinically as a fibroadenoma. Most specimens contained a well-circumscribed tumor with a firm white-gray cut surface. In six cases, there was no discrete gross lesion in the surgical specimen. Microscopically, there was a spectrum of pathological stromal changes ranging from classical PASH with anastomosing slit-shaped spaces outlined by flat, bland spindle cells to more proliferative lesions composed of bundles of plump spindle cells that obscured the underlying pseudoangiomatous architecture in the most florid lesions. The spindle cells were vimentin and CD34 positive and factor VIII negative. In more cellular fascicular lesions, the stromal cells acquired desmin and actin positivity. These immunohistochemical features were consistent with myofibroblastic histogenesis of PASH. Reactivity for progesterone receptor (PR) typically exceeded estrogen receptor (ER) in the nuclei of stromal and glandular cells. In most lesions, the nuclei of stromal spindle cells were ER negative. The majority of the patients were treated by excisional biopsy. One lesion, incompletely excised, spontaneously regressed. One patient had bilateral mastectomies. Follow-up was 0.6-11 years (mean, 4.5 years). Five patients had ipsilateral recurrences, and two had subsequent contralateral PASH. The morphological spectrum of cellular proliferation and staining qualities indicates that the myofibroblast plays a major role in the histogenesis of PASH. The pathogenesis of PASH remains uncertain, but aberrant reactivity of myofibroblasts to endogenous or exogenous hormones is likely to be an important factor. Simple excision is adequate treatment initially and for infrequent recurrences, Diffuse PASH occasionally presents a difficult management problem that may necessitate mastectomy.

Langerhans Cells in Langerhans Cell Histiocytosis and Peripheral Adenocardnomas of the Lung

The present paper deals with more precise characterization of Langerhans cells (LC) and accompanying lymphocytes in lung LC histiocytosis (LCH) and primary lung peripheral adenocarcinomas using immunohistochemical methods with various kinds of monoclonal antibodies against cell adhesion and activation markers and some cytokines. Tissue specimens were obtained from 4 patients with pulmonary LCH and from 29 patients with primary lung peripheral adenocarcinoma. In florid (exudative and granulomatous) nonfibrotic LCH lesions, LC, particularly those in contact with lymphocytes, were S100, CD1a, MHC Class II, CD11a and c, CD16, and CD54 positive. In this context, LC were CD4+ and CD25+. Lymphocytes around LC were CD3+ with a "memory" phenotype (CD45RO+) and, frequently, CD25+ and HLA-DR+. S100+ and CD1a+ LC were commonly observed in adenocarcinomas subclassified as papillary and as nonmucinous bronchioloalveolar, in both cases mainly where Clara cells and Type II pneumocytes were present. In carcinomas the vast majority of LC were HLA-DR+ and, rarely, weakly CD16+, CD25+, and CD54+. The infiltration of reactive cells in cancer tissue was mainly represented by T lymphocytes (CD3+CD45RO+). These T cells were HLA-DR- and CD25-. The presence of LC was associated with a strong reactivity of epithelial cells with antibodies PE-10 and 439-9B, both recognizing molecules mainly expressed by Type II alveolar cells. Several cells in LCH florid lesions showed immunoreactivity for both IL-1 alpha and beta. Immunostaining for IFN-gamma revealed the presence in the same areas of some positive cells showing lymphoid morphology. No IL-1 or IFN-gamma reactivity was found in adenocarcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Colon cancer genetics.

The terms "hereditary," "sporadic," and "familial" colorectal cancer (CRC) suggest a knowledge of causation; however, current understanding of CRC does not permit categorization of differing CRC risks in accord with their cause per se. Despite these serious shortcomings, these terms are defined operationally on the basis of a family history of cancer, and when available, additional phenotypic information. The sporadic type occurs in the absence of a family history of CRC in a first-degree relative. The familial type occurs when at least one first-degree relative has CRC. Both these categories require the exclusion of hereditary CRC. In the case of hereditary CRC, this type is defined as a family history of CRC occurring in a pattern that indicates autosomal-dominant inheritance, which also may involve certain phenotypic signs (depending on the specific disorder, i.e., florid adenomatous polyps, benign and malignant extracolonic lesions, cancer of unusually early onset, and multiple primary cancer, particularly synchronous and metachronous CRC). Although this operational classification does not produce etiologically homogeneous groups, it is believed to have pragmatic utility with respect to planning targeted surveillance and management strategies. Because of the distinctive natural history of CRC in hereditary syndromes, it is of paramount clinical importance to identify hereditary CRC when it does occur. Even in patients with no evidence of hereditary CRC syndrome, their family history may be second only to age in determining the best CRC screening program for those who are asymptomatic. In an attempt to provide a perspective on the clinical evaluation of CRC risk, research was reviewed on pathologic features and biomarkers that may be related to CRC causes, especially the genetic basis of CRC susceptibility. The long-term objective of studies on the genetic epidemiology of CRC is primary and secondary prevention through development of targeted management and surveillance recommendations (based on an understanding of CRC causation) that is relevant to hereditary, familial, and sporadic CRC.

Histology, Immunohistochemistry, and Ultrastructure of the Verruga in Carrionʼs Disease

Twenty-six verruga peruana nodules were studied. The presence of Factor VIII-related antigen and Ulex europaeus lectin binding, and the ultrastructural finding of rudimentary cell junctions and pinocytotic vesicles establish the endothelial character of the proliferating cells in the verruga nodules. Whereas superficial lesions could show an angiomatoid pattern, deep-situated nodules tended to present a compact type of growth. Electron-microscopic studies have shown that Bartonella bacilliformis was found abundantly in the extracellular spaces in the florid lesions and that no organisms were present in the late, resolving subcutaneous nodules. Although no true intracellular "viable" microorganisms were noted, pseudopods of cytoplasm entrapping one or two bacteria and surrounding matrix substance were seen often. The characteristics of cytoplasmic inclusions previously described in verruga cells as "chlamydozoa" were detailed. The ultrastructure of the inclusions corresponded to endothelial phagocytic cells in which complex invaginations of the cell surface had produced a labyrinth of interconnected channels and vacuoles containing degraded bacteria, extracellular matrix components, or both. We conclude that in light microscopy the finding of Rocha-Lima's inclusions is the only definite morphologic evidence of the presence of bartonella in verruga lesions.

Squamous papillomas of the larynx in adults. A review of 63 cases.

Sixty-three cases of squamous papillomas of the larynx occurring in adults are presented. Twelve cases started as juvenile papillomas and continued into adult life. Twice as many males as females were in the series. The papillomas were always present on the true vocal cords at presentation, although other parts of the larynx were involved to a variable extent. The symptom of hoarseness gave a good indication as to the state of the larynx during treatment. Malignancy did not develop in patients with papillomas which fulfilled the histological criteria. Papillomas are clusters of thin, cylindrical projections of squamous epithelial covered mucosa with second and even third order branching. Biopsies in 5 cases show papillomatosis of respiratory epithelium, a process which is here described in the larynx for the first time. The prognosis as regards recurrence for 20 patients with solitary lesions was good, for 38 patients with multiple lesions reasonable, but for 5 patients with extensive florid lesions was exceptionally poor.

Etiology of the liver granulomatous response in Schistosoma mansoni-infected athymic nude mice.

The effect of schistosome infection on the presence and maturation of splenic T lymphocytes in C3H/HeN nu/nu and nu/+ mice was examined. Spleens of uninfected nu/nu mice contained very low numbers (u to 2%) of T lymphocytes. This percentage did not increase throughout the 10 weeks of the infection. Spleens of uninfected nu/+ littermates contained 28.8% T cells, which decreased to 15.0% by week 10 of the infection. Similarly, whereas spleen cells of normal or infected nu/nu mice were nonresponsive to concanavalin A, the initial high response of nu/+ mice gradually diminished. Both nu/nu and nu/+ spleen cells responded well to lipopolysaccharide initially, but by 10 weeks their responsiveness declined. Sera of five infected nu/nu mice contained no antibodies to egg antigens, and one had a low titer (log2 5.0). In contrast, the mean titer of sera from six nu/+ mice was log2 10.7 Nu/+ mice had typical florid lesions, but nu/nu mice mounted sparse granulomatous reactions around eggs in the liver without evidence for hepatocellular damage. Dispersed liver granulomas of nu/nu mice contained 1.2% T and 20.3% B lymphocytes. Lesions of nu/+ mice contained 12.9% T and 18.4% B cells. Eighty percent of the macrophages from nu/nu and nu/+ granulomas displayed high density/avidity Fc receptors. Production of migration inhibition factor-active lymphokine by liver granulomas and spleens of schistosome-infected nu/nu mice is suggestive of the immune role of B cells in the granulomatous inflammation.

Case Reports from an African Hospital (First Series)

The reluctance of the African to seek medical advice is largely governed by fear, superstition and economic pressures, which still exist in Central Africa, although not to the same extent as in the pre-war era. This results not only in the presentation of uncommon and perhaps typically African diseases, but also in the more florid lesions now uncommonly seen in more developed countries. The Mpilo African Hospital, Bulawayo, from which the following cases are drawn, contains more than 800 beds and serves an African population of over 1,000,000 who inhabit an area roughly one and a quarter times the size of England, with living conditions and environment ranging from primitive kraal to modern city life. An African male, aged approximately 60 years, was admitted for investigation of a fairly mobile, hard mass in the epigastrium, which he had noticed one month previously. It was non-tender and apart from some weight loss there was no relevant history. Barium meal. This revealed in the erect position a smooth deep indentation of the greater curvature of the distal third of the stomach, the mucosa showed no abnormality (Fig. 1). The indentation was not apparent in the supine and prone positions. The duodenal loop was partially reversed, its third part lying behind the stomach in the erect position, but above the lesser curvature of the stomach in the supine position. No lateral or anterior gastric displacement was apparent. A tentative diagnosis of an atypical pancreatic mass was made.

Treponematoses in Gambia, West Africa

1. (1) Surveys for treponemal disease were made in Gambia, West Africa, of villages of the main tribes scattered throughout the country. Approximately 7,500 persons were examined once during the dry season and again during the rains. Serological investigations employing S.T.S. and T.P.I. tests were undertaken in London. 2. (2) The early lesions of yaws, i.e. florid lesions on the skin, were found in one village, and a second form of non-venereal treponematosis known locally as siti was found in four out of five villages of the Fula tribe. 3. (3) The early lesions of siti occurred on mucous membranes of the mouth, and the tip of the penis of small boys before puberty. Florid lesions were found on the vulva and round the anus. Circinate lesions were found on the skin and also axillary lesions resembling yaws. Sera from the above lesions contained treponemes morphologically identical with T. pallidum, and the serological tests in these cases were positive. 4. (4) The most common late manifestation of treponemal disease in Gambia appeared to be depigmentation, particularly depigmentation of the hands. It has been shown statistically that depigmentation of the hands is probably due to treponemal disease. Other late manifestations were too infrequently seen for accurate conclusions to be drawn. 5. (5) No evidence was found of the development of lesions of the cardiovascular or central nervous systems. 6. (6) Contractures of the fingers were encountered in 3 per cent. of the female population and in 1.9 per cent. of the male population. These figures are significantly different. No statistical evidence was found to suggest that contractures were the result of treponemal infection. 7. (7) Siti appeared to be transmitted by the use of a common drinking-cup and common food-bowl, and close personal contact. 8. (8) Gambia lies at the edge of the tropical rain-belt, and the climatic conditions are unusual in that there is one short, intense rainy season and a long dry season, giving for part of the year a desert climate and for a short part of the year a humid climate. The fact that both yaws and the other form of non-venereal treponematosis were found side by side is believed to be further evidence in the hypothesis of the common aetiological agent of the treponematoses, and that the clinical manifestations are affected, among others, by climate. 9. (9) It is suggested that the term “endemic syphilis” is a misnomer and should be abolished; and that, with the exception of the Bosnian form of the disease, all the non-venereal treponematoses, including yaws, should be classed together.