Multinucleated Foreign Body Giant Cells Research Articles

Electrospun Composites of Chitosan with Cerium Oxide Nanoparticles for Wound Healing Applications: Characterization and Biocompatibility Evaluation In Vitro and In Vivo.

Cerium oxide nanoparticles (CeONPs), as part of tissue regeneration matrices, can protect cells from reactive oxygen species and oxidative stress. In addition, they can influence the properties of the scaffold, including its electrospinnability and mechanical strength. In this work, we prepared electrospun fiber mats from a chitosan and polyethylene oxide blend (CS-PEO) with the addition of ceria nanoparticles (CS-PEO-CeONP). The addition of CeONPs resulted in a smaller fiber diameter and higher swelling compared to CS-PEO fiber mats. CeONP-modified fiber mats also had a higher Young's modulus due to the reinforcing effect of the nanoparticles. Both mats had comparable adhesion and cytocompatibility to mesenchymal stem cells, which had a more rounded morphology on CS-PEO-CeONP compared to elongated cells on the CS-PEO mats. Biocompatibility in an in vivo rat model showed no acute toxicity, no septic or allergic inflammation, and no rough scar tissue formation. The degradation of both mats passed the stage of matrix swelling. CS-PEO-CeONP showed significantly slower biodegradation, with most of the matrix remaining in the tissue after 90 days. The reactive inflammation was aseptic in nature with the involvement of multinucleated foreign-body type giant cells and was significantly reduced by day 90. CeONPs induced the formation of the implant's connective tissue capsule. Thus, the introduction of CeONPs influenced the physicochemical properties and biological activity of CS-PEO nanofiber mats.

Extreme Serum Titanium Concentration Induced by Acetabular Cup Failure: Unveiling a Unique Scenario of Titanium Alloy Debris Accumulation.

The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTRs) compared to CoCr alloys. This study presents a case of unusual primary THA failure where a substantial release of Ti alloy debris was observed. A 52-year-old active male underwent THA after post-traumatic aseptic necrosis of the femoral head in 2006. Seventeen years after the procedure, the patient presented with groin pain and a restricted range of motion. X-rays revealed the protrusion of the alumina ceramic head through the Ti6Al4V acetabular cup. Trace element analysis indicated significantly elevated levels of serum Ti, Al, and V. CT and MRI confirmed Ti alloy cup failure and a severe ALTR. During revision surgery, it was found that the worn-out ceramic head was in direct contact with the acetabular cup, having protruded through a central hole it had created over time. No acetabular liner was found. Histological analysis of his tissue samples showed wear-induced synovitis with areas of multinucleated foreign body giant cells and the accumulation of numerous metal particles but no acute inflammatory response. Six months after the revision THA, the patient has experienced favourable outcomes. This case provides an instructive illustration for studying the consequences of the substantial release of Ti alloy debris from orthopedic implants.

Innate immunity response of zafirlukast treated-tilapia during foreign body inflammation

There is limited knowledge regarding the blockade of cysteinyl leukotriene receptors (CysLTRs) and their effects in teleost fish. The present study investigated the effects of Zafirlukast, antagonist of CysLTR1 receptor, on the foreign body inflammatory reaction in Nile tilapia (Oreochromis niloticus). Zafirlukast-treated tilapia demonstrated a decrease in the formation of multinucleated foreign body giant cells and Langhans cells on the round glass coverslips implanted in the subcutaneous tissue, along with a significant reduction in white blood cell counts and decreased production of reactive oxygen species. There was an increase in serum levels of α2-macroglobulins, as well as a decrease in ceruloplasmin and haptoglobin. Zafirlukast treatment led to a significant decrease in the area of splenic melanomacrophage centers and a reduction in the presence of lipofuscin. These findings highlight the potential anti-inflammatory effects of zafirlukast treatment in tilapia and indicate its action on CysLTR1 receptor, modulating the innate immune response of tilapia during the foreign body reaction. The comprehension of chronic inflammation mechanisms in fish has become increasingly relevant, especially concerning the utilization of biomaterials for vaccine and drug delivery.

Clinical and histopathological features of conjunctival "Teddy bear" granuloma: A case series.

To describe the clinical features, histopathological findings, and prognosis of conjunctival Teddy bear granuloma (TBG) diagnosed in a Mexican ophthalmologic referral center in a period of 64 years. We reviewed clinical and histopathological material from all patients with documented conjunctival TBG. Patient's age, gender, location, clinical signs and symptoms, duration, treatment and, specimen size, were evaluated. Formalin-fixed paraffin embedded 5 microns hematoxylin-eosin stained slides and periodic acid-Schiff special stain as well as examination under polarized light microscopy were performed in all cases. A total of 5 conjunctival TBG were collected. The ages of the patients ranged between 2 and 11 with a mean of 6 years. Female to male ratio was 4:1. The right inferior fornix was involved in 4 cases (80%) with clinical diagnosis of conjunctival mass of unknown etiology. Treatment consisted of surgical removal by slit-lamp biomicroscopy (3 cases) and in the operating room (2 cases). No complications were informed in a short follow-up period. Histopathologically, numerous cross-sections of synthetic and non-synthetic fibers surrounded by multinucleated foreign body giant cells, epithelioid histiocytes, lymphocytes, plasma cells and sparse neutrophils were seen. Polarization light microscopy demonstrated numerous birefringent colorful foreign fibers. The follow-up period of the patients ranged between 1 and 32 weeks with a mean of 10 weeks. Most patients with TBG are children with vague, non-specific symptoms troubling precise clinical diagnosis. Treatment of choice involves surgical excision of the foreign body granuloma followed by topical corticosteroids. All surgical specimens obtained must be sent for histopathological examination. Special awareness is recommended during COVID-19 pandemic lockdown to prevent potential exposure to fibers that may cause conjunctival TBG.

Systemic immune response to vimentin and granuloma formation in a model of pulmonary sarcoidosis

A characteristic feature of sarcoidosis is a dysregulated immune response to persistent stimuli, often leading to the formation of non-necrotizing granulomas in various organs. Although genetic susceptibility is an essential factor in disease development, the etiology of sarcoidosis is not fully understood. Specifically, whether autoimmunity contributes to the initiation or progression of the disease is uncertain. In this study, we investigated systemic autoimmunity to vimentin in sarcoidosis. IgG antibodies to human vimentin were measured in sera from sarcoidosis patients and healthy controls. Mice immunized with recombinant murine vimentin were challenged intravenously with vimentin-coated beads to mimic pulmonary sarcoidosis. Lungs from treated mice were studied for cellular infiltration, granuloma formation, and gene expression. Immune cells in the bronchoalveolar lavage fluid were evaluated by flow cytometry. Compared to healthy controls, sarcoidosis patients had a higher frequency and levels of circulating anti-vimentin IgG. Vimentin-immunized mice developed lung granulomas following intravenous challenge with vimentin-coated beads. These sarcoidosis-like granulomas showed the presence of Langhans and foreign body multinucleated giant cells, CD4 T cells, and a heterogeneous collection of MHC II positive and arginase 1-expressing macrophages. The lungs showed upregulated pro-inflammatory gene expression, including Ifng, Il17, and Tnfa, reflecting TH1/TH17 responses typical of sarcoidosis. In addition, genes in the TH2 canonical pathway were also upregulated, congruent with increased numbers of ILC2 in the bronchoalveolar lavage. Overall, these results further validate vimentin as an autoantigen in sarcoidosis and provide evidence for an anti-vimentin immune response in disease pathogenesis. Our study also highlights the possible role of ILC2-driven TH2-like responses in the formation of lung granulomas in sarcoidosis.

A case of gastric adenocarcinoma extirpated with total gastrectomy involving jejunal pouch reconstruction

Gastric adenocarcinoma usually has a poor prognosis due to its late diagnosis in most cases. Gastric adenocarcinomas account for 95% of all malignant tumors of the stomach. In this report, we described a case of a 63-year-old man who presented with pain in the epigastric region for 1 month which was associated with hematemesis and loss of appetite. The upper gastrointestinal endoscopy (UGIE) revealed an ulcer of size 3 cm × 3 cm in the lesser curvature of the stomach. The patient underwent open total gastrectomy, dissection D2, and a jejunal pouch of 30 ml additional capacity was created 20 cm distal to duodenojejunal flexure and passed retrocolic from a rent in transverse mesocolon. The patient was sent to chemoradiotherapy after the surgery and discharged on the 24th day after surgery. Postoperative biopsy revealed tumor tissue showing irregular, ill-defined, and glandular clouding with loss of polarity. Infiltration was up to the muscularis layer and mesenteric lymph nodes showed partial effacement of architecture with reactive changes and few multinucleated foreign body giant cells confirming the diagnosis as poorly differentiated adenocarcinoma of the stomach of II B class (T2 N2 M0) as per the Union for International Cancer Control guidelines.

Pulmonary hair embolism in a rescued free-ranging Eurasian otter Lutra lutra in Kinmen, Taiwan.

Eurasian otters Lutra lutra are listed as Near Threatened on the IUCN Red List and are imperiled by habitat loss, water pollution, and poaching. Harassment and attacks by stray animals are also recognized threats to the health of wild Eurasian otters. Pulmonary hair embolism is a possible complication in animals with deep traumatic injury, but to date no cases have been reported in wildlife. A free-ranging, adult male Eurasian otter was rescued due to severe emaciation and multiple bite wounds. The otter died 3 d after rescue and was necropsied. Grossly, a 1.5 × 1.5 × 1.5 cm firm nodule was observed in the left cranial lung lobe. Histologically, a fragment of hair shaft surrounded by multinucleated foreign body giant cells was observed in a medium-sized vein, and extensive eosinophilic infiltration was noted in the adjacent vascular wall and lung parenchyma. Based on the gross and histological findings, the pulmonary lesion was consistent with eosinophilic pneumonia and vasculitis induced by hair embolism. The presence of well-formed multinucleated foreign body giant cells and eosinophils may imply a late stage of foreign body reaction, and thus the presumptive source of hair embolism is an animal bite. This is the first report of pulmonary hair embolism associated with animal bite in a rescued free-ranging Eurasian otter.

Electrospun Nanofiber Meshes With Endometrial MSCs Modulate Foreign Body Response by Increased Angiogenesis, Matrix Synthesis, and Anti-Inflammatory Gene Expression in Mice: Implication in Pelvic Floor.

PurposeTransvaginal meshes for the treatment of Pelvic Organ Prolapse (POP) have been associated with severe adverse events and have been banned for clinical use in many countries. We recently reported the design of degradable poly L-lactic acid-co-poly ε-caprolactone nanofibrous mesh (P nanomesh) bioengineered with endometrial mesenchymal stem/stromal cells (eMSC) for POP repair. We showed that such bioengineered meshes had high tissue integration as well as immunomodulatory effects in vivo. This study aimed to determine the key molecular players enabling eMSC-based foreign body response modulation.MethodsSUSD2+ eMSC were purified from single cell suspensions obtained from endometrial biopsies from cycling women by magnetic bead sorting. Electrospun P nanomeshes with and without eMSC were implanted in a NSG mouse skin wound repair model for 1 and 6 weeks. Quantitative PCR was used to assess the expression of extracellular matrix (ECM), cell adhesion, angiogenesis and inflammation genes as log2 fold changes compared to sham controls. Histology and immunostaining were used to visualize the ECM, blood vessels, and multinucleated foreign body giant cells around implants.ResultsBioengineered P nanomesh/eMSC constructs explanted after 6 weeks showed significant increase in 35 genes associated with ECM, ECM regulation, cell adhesion angiogenesis, and immune response in comparison to P nanomesh alone. In the absence of eMSC, acute inflammatory genes were significantly elevated at 1 week. However, in the presence of eMSC, there was an increased expression of anti-inflammatory genes including Mrc1 and Arg1 by 6 weeks. There was formation of multinucleated foreign body giant cells around both implants at 6 weeks that expressed CD206, a M2 macrophage marker.ConclusionThis study reveals that eMSC modulate the foreign body response to degradable P nanomeshes in vivo by altering the expression profile of mouse genes. eMSC reduce acute inflammatory and increase ECM synthesis, angiogenesis and anti-inflammatory gene expression at 6 weeks while forming newly synthesized collagen within the nanomeshes and neo-vasculature in close proximity. From a tissue engineering perspective, this is a hallmark of a highly successful implant, suggesting significant potential as alternative surgical constructs for the treatment of POP.

Autologous blood coagulum is a physiological carrier for BMP6 to induce new bone formation and promote posterolateral lumbar spine fusion in rabbits.

In the present study, we describe autologous blood coagulum (ABC) as a physiological carrier for BMP6 to induce new bone formation. Recombinant human BMP6 (rhBMP6), dispersed within ABC and formed as an autologous bone graft substitute (ABGS), was evaluated either with or without allograft bone particles (ALLO) in rat subcutaneous implants and in a posterolateral lumbar fusion (PLF) model in rabbits. ABGS induced endochondral bone differentiation in rat subcutaneous implants. Coating ALLO by ABC significantly decreased the formation of multinucleated foreign body giant cells (FBGCs) in implants, as compared with ALLO alone. However, addition of rhBMP6 to ABC/ALLO induced a robust endochondral bone formation with little or no FBGCs in the implant. In rabbit PLF model, ABGS induced new bone formation uniformly within the implant resulting in a complete fusion when placed between two lumbar transverse processes in the posterolateral gutter with an optimum dose of 100‐μg rhBMP6 per ml of ABC. ABGS containing ALLO also resulted in a fusion where the ALLO was replaced by the newly formed bone via creeping substitution. Our findings demonstrate for the first time that rhBMP6, with ABC as a carrier, induced a robust bone formation with a complete spinal fusion in a rabbit PLF model. RhBMP6 was effective at low doses with ABC serving as a physiological substratum providing a permissive environment by protecting against foreign body reaction elicited by ALLO.

A CASE OF TATTOO SARCOIDOSIS

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Sarcoidosis is a multisystem granulomatous disease that commonly affects the lungs and intrathoracic lymph nodes. In rare cases, it can present as localized hypersensitive reaction to a pre-existing chemical irritant with symptoms limited to areas of granuloma formation. When it affects the lungs and mediastinal lymph nodes, as seen in over 90% of patients, it causes lymphadenopathy associated with cough, dyspnea, and interstitial lung disease. Here we present a case of Sarcoidosis diagnosed in the setting of hypersensitive reaction to a pre-existing tattoo. CASE PRESENTATION: A 61-year-old Caucasian woman presented to dermatologist for evaluation of gradually worsening eyebrow redness, swelling, and pruritus. On physical exam, she was noted to have small, scattered <1 cm areas of raised non-blanching macules limited to where she had received a cosmetic eyebrow tattoo about four years prior to presentation. A skin biopsy of the affected area showed mixed inflammatory infiltrate with numerous epithelloid histiocytes, multinucleated foreign body giant cells, lymphocytes, plasma cells, and a few eosinophils intermixed with tattoo particulate deposition. Skin biopsy was negative for fungal and acid fast bacilli. She was referred to Pulmonology, who she saw four months later, with complaints of fatigue, dry cough and dyspnea on exertion. She denied any chest tightness, wheezing, palpitations, fever, chills or unexpected weight loss. Chest X-ray and CT Chest w/o contrast showed mediastinal bilateral hilar lymphadenopathy and peribronchovascular bundle nodules. She had ACE level 85 IU/L and ESR 25 mm/h. PFTs showed moderate obstructive defect with FEV-1 of 68%. She had no history of COPD or asthma. She was started on long course of Prednisone with taper. At one-month follow-up visit, the patient reported improvement with resolution of shortness of breath and skin changes including eyebrow redness and swelling. DISCUSSION: As this case illustrates, sarcoidal reaction within a pre-existing tattoo can be the sole presenting symptom leading to the diagnosis of systemic sarcoidosis. Other associated findings of dyspnea, hilar lymphadenopathy on CT were seen later in time. It has been proposed that exposure to foreign antigens triggers dysregulated TH-1 inflammatory response activating the CD4 T-helper cells and macrophages. The latent period can range anywhere from months to ten years and it is unknown if tattoo removal affects the progression of the disease. CONCLUSIONS: Sarcoidosis is a diagnosis of exclusion and requires clinical and radiographic findings compatible with histological confirmation of noncaseating granulomas. With the increasing popularity of cosmetic tattoos and techniques to enhance the appearance of eyebrows via addition of pigment to skin, a simple hypersensitivity reaction with supporting pathological and radiologic evidence can lead to the diagnosis of this multisystem disease. Reference #1: Marcoval J, Mañá J, Moreno A, Gallego I, Fortuño Y, Peyrí J. Foreign Bodies in Granulomatous Cutaneous Lesions of Patients With Systemic Sarcoidosis. Arch Dermatol. 2001;137(4):427–430. doi: 10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-137-4-dst0038 Reference #2: Antonovich D.D., Callen J.P. Development of sarcoidosis in cosmetic tattoos. Arch Dermatol. 2005;141:869–872 Reference #3: P. P. Papageorgiou, W. Hongcharu, A. C. Chu. Systemic sarcoidosis presenting with multiple tattoo granulomas and an extra-tattoo cutaneous granuloma. J Eur Acad Dermatol Venereol. 1999 Jan; 12(1): 51–53 DISCLOSURES: No relevant relationships by Mudher Al Shathir, source=Web Response No relevant relationships by Himani Bhasin, source=Web Response No relevant relationships by Kenneth DSouza, source=Web Response

Live imaging the foreign body response in zebrafish reveals how dampening inflammation reduces fibrosis.

ABSTRACTImplanting biomaterials in tissues leads to inflammation and a foreign body response (FBR), which can result in rejection. Here, we live image the FBR triggered by surgical suture implantation in a translucent zebrafish model and compare with an acute wound response. We observe inflammation extending from the suture margins, correlating with subsequent avascular and fibrotic encapsulation zones: sutures that induce more inflammation result in increased zones of avascularity and fibrosis. Moreover, we capture macrophages as they fuse to become multinucleate foreign body giant cells (FBGCs) adjacent to the most pro-inflammatory sutures. Genetic and pharmacological dampening of the inflammatory response minimises the FBR (including FBGC generation) and normalises the status of the tissue surrounding these sutures. This model of FBR in adult zebrafish allows us to live image the process and to modulate it in ways that may lead us towards new strategies to ameliorate and circumvent FBR in humans.This article has an associated First Person interview with the first author of the paper.

P4. Autologous blood coagulum as a native carrier for rhBMP6 induces new bone formation and posterolateral lumbar spine fusion in rabbits and sheep

BACKGROUND CONTEXT RhBMP2 soaked in bovine tendon collagen and synthetic ceramics composite as well as rhBMP7/OP1 lyophilized in bovine bone collagen particles with additive carboxyl-methyl cellulose have been evaluated for posterolateral lumbar fusion (PLF). We investigated rhBMP6 delivered in autologous blood coagulum (ABC), a native carrier (scaffold), with and without allograft bone particles (ALLO) to induce new bone formation and promote posterolateral lumbar spine fusion (PLF) in rabbit and sheep. PURPOSE To evaluate the efficacy of RhBMP6 with autologous blood coagulum (ABC) alone or with ABC and allograft (ALLO) will induce a successful posterolateral spinal fusion in animal models. STUDY DESIGN/SETTING Preclinical evaluation of spine fusion in animal models. PATIENT SAMPLE Multiple experimental groups of rats, rabbits and sheep. OUTCOME MEASURES Radiographic and histologic evaluation for bone formation and spinal fusion. METHODS An autologous bone graft substitute (ABGS) was fabricated by dispersing rhBMP6 in ABC with and without ALLO and evaluated for bone induction in rat subcutaneous implants and to promote bone formation in posterolateral lumbar fusion in preclinical models. The cellular response of bone induction and the quantity and quality of newly formed bone were examined by histology, radiographs, micro-CT analyses at various time intervals. RESULTS ABGS with and without ALLO induced new bone formation in rat implants. ALLO alone induced formation of multinucleated foreign body giant cells (FBGCs). However, ALLO plus ABC decreased the formation of FBGCs. The addition of rhBMP6 to ABC/ALLO, resulted in fewer or no FBGCs. In Rabbits, the groups with ABC alone or with ALLO did not fuse. The 50 micrograms rhBMP6 group only 2 out of 4 animals successfully fused. In the 100 micrograms, 200 micrograms and 400 micrograms rhBMP6 groups all animals successfully fused. In sheep, the groups with ABC or ABC with ALLO failed to fuse. In the rhBMP6 187.5 micro grams/ml group with ABC and instrumentation fusion was achieved in 83% (10/12 animals). In the 187.5 micro grams/ml group with ABC, ALLO and instrumentation, fusion was achieved in 93% (11/12 animals). Bone formation occurred uniformly within ABGS implants where the ALLO was replaced by the newly formed bone via creeping substitution. CONCLUSIONS RhBMP6 with autologous blood coagulum (ABC) alone or with ABC and allograft (ALLO) induced a robust bone formation in posterolateral spinal fusion in preclinical models. FDA DEVICE/DRUG STATUS RhBMP6 (Not approved for this indication).

Massive Silicone-Induced Orbital Granuloma

We report a large subconjunctival-orbital granuloma in a 51-year-old male presenting with a blind painful right eye and marked chemosis 15 months after undergoing vitrectomy and silicone oil retinal tamponade for retinal detachment with no reported intraoperative complications. Gross and histopathologic examination of the enucleated eye and episcleral tumor revealed a bosselated mass measuring 17 × 10 × 5 mm containing prominent vacuoles with surrounding epithelioid histiocytes and foreign body multinucleated giant cells. Such a large silicone-induced orbital granuloma following uncomplicated retinal surgery in a grossly intact eye has not been previously reported to the authors’ knowledge. High intraocular pressure and emulsification of oil may facilitate silicone extravasation through scleral wounds after retinal surgery.

Porous Phosphate-Based Glass Microspheres Show Biocompatibility, Tissue Infiltration, and Osteogenic Onset in an Ovine Bone Defect Model.

Phosphate-based glasses (PBGs) are bioactive and fully degradable materials with tailorable degradation rates. PBGs can be produced as porous microspheres through a single-step process, using changes in their formulation and geometry to produce varying pore sizes and interconnectivity for use in a range of applications, including biomedical use. Calcium phosphate PBGs have recently been proposed as orthobiologics, based on their in vitro cytocompatibility and ion release profile. In this study, porous microspheres made of two PBG formulations either containing TiO2 (P40Ti) or without (P40) were implanted in vivo in a large animal model of bone defect. The biocompatibility and osteogenic potential of these porous materials were assessed 13 weeks postimplantation in sheep and compared to empty defects and autologous bone grafts used as negative and positive controls. Histological analysis showed marked differences between the two formulations, as lower trabeculae-like interconnection and higher fatty bone marrow content were observed in the faster degrading P40-implanted defects, while the slower degrading P40Ti material promoted dense interconnected tissue. Autologous bone marrow concentrate (BMC) was also incorporated within the P40 and P40Ti microspheres in some defects; however, no significant differences were observed in comparison to microspheres implanted alone. Both formulations induced the formation of a collagen-enriched matrix, from 20 to 40% for P40 and P40Ti2.5 groups, suggesting commitment toward the bone lineage. With the faster degrading P40 formulation, mineralization of the tissue matrix was observed both with and without BMC. Some lymphocyte-like cells and foreign body multinucleated giant cells were observed with P40Ti2.5, suggesting that this more durable formulation might be linked to an inflammatory response. In conclusion, these first in vivo results indicate that PBG microspheres could be useful candidates for bone repair and regenerative medicine strategies and highlight the role of material degradation in the process of tissue formation and maturation.

Incidental Jejunal Anisakiasis in a Patient Presenting With Small Bowel Obstruction

Anisakiasis is a parasitic infection of the gastrointestinal tract caused by the consumption of undercooked seafood containing larvae of Anisakis simplex. Its prevalence is higher in areas where fish is consumed raw, salted or lightly pickled. A 70-year-old Caucasian female presented with acute nausea, vomiting and periumbilical abdominal pain. She had a past medical history of inflammatory arthritis, on hydroxychloroquine, and a surgical history of three prior cesarean sections, hysterectomy and appendectomy. On exam, she had a distended abdomen and diffuse moderate tenderness to palpation with no rebound or guarding. Laboratory studies were unremarkable, with no eosinophilia. Computed Tomography showed a small bowel obstruction with a short segment closed loop in the left paramidline supraumbilical region. After failing conservative management, she underwent surgical exploration. The small bowel was found to be obstructed due to an internal hernia, which was surgically repaired and did not require bowel resection. While the small bowel was being run, a small one cm pedunculated mass attached to the serosal surface of the jejunum was incidentally encountered 15 centimeters distal to the Ligament of Treitz. This mass did not involve the portion of small bowel within the internal hernia. A 4 cm segment of small bowel including the mass was resected. Histopathology of the mass showed abscess formation with granulomatous inflammation, necrosis, chronic inflammation, foreign body multinucleated giant cells and numerous eosinophils. Deeper levels of the abscess showed an Anisakis type larva with a multilayered cuticle. Further history revealed that she eats raw seafood regularly, including eating lightly cooked fresh caught tuna two months prior to presentation. She recovered from her surgery and was discharged home.Humans become infected with Anisakis when they eat intermediate hosts, such as squid or fish that are undercooked or raw. The parasite will attempt to burrow in the intestinal wall, causing a granulomatous inflammation, which eventually results in the death of the parasite. Symptoms on presentation depends on the organ location of the invasion by the nematode. Gastric anisakiasis typically causes acute abdominal pain whereas intestinal anisakiasis can be more indolent and cause granulomatous inflammation, at times resembling Crohn's disease. Visualization of the parasite via upper endoscopy allows for diagnosis and removal, which is curative.2510 Figure 1. Histopathology of the mass showed abscess formation with granulomatous inflammation, necrosis, chronic inflammation, foreign body multinucleated giant cells and numerous eosinophils. Deeper levels of the abscess showed an Anisakis type larva with a multilayered cuticle.

UNUSUAL CASE OF INTERSTITIAL LUNG DISEASE

SESSION TITLE: Diffuse Lung Disease 1 SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/07/2018 03:30 pm - 04:30 pm INTRODUCTION: Interstitial Lung Disease can be associated with a broad range of diseases, exposures, drugs, and can be idiopathic. Silicosis has been understood as a cause of pulmonary disease for centuries. Silicosis inhalation is seen by occupational exposure such as sandblasting, mining, and masonry. Injected silicone is a liquid form of silicone and is commonly used in plastic and reconstructive surgery. We present a case of silicone injection that caused pulmonary fibrosis. CASE PRESENTATION: A middle aged Transgender female underwent breast implants and silicone thigh, gluteal, and hip injections. The injections were done in by unlicensed non-physician practitioners located in a home. Two weeks after the procedures the patient developed a severe skin reaction causing infection and skin breakdown. Several weeks after recovery the breast implants opened and caused skin necrosis and infection in the breasts. A bilateral mastectomy had to be completed. After recovery the skin became thickened and fibrotic. Two years later the patient developed worsening shortness of breath, dyspnea on exertion, and hypoxia. She presented to the emergency room where a chest xray showed bilateral upper lobe infiltrates. A CT chest showed severe fibrotic changes in middle and upper lung zones. Associated groundglass opacities, mild bronchiectasis, and interlobular connective-tissue thickening in bilateral lower lobes was also present. Pulmonary function tests noted severe restrictive lung disease with severely low oxygen exchange. Pathology of surgical biopsy showed extensive multinucleated foreign body giant cells. Many of the giant cells included non-polarizable microdroplets which were suggestive of silicone droplets. DISCUSSION: Acute lung injury from venous or arterial injection is most understood complication in literature. Chronic injury causing progressive massive fibrosis is rare. When silicone is mixed with soft tissue a fibroblastic response is generated. With history, clinical findings, imaging, and pathology our suspicion of silicone injection induced lung fibrosis was confirmed. CONCLUSIONS: Silicone is considered as inert agent, physicians especially pulmonologists need to be aware of its complications which may range from local tissues necrosis to progressive massive fibrosis1. Risk of complications increases with illicit injections or if performed by unskilled practitioners. Most of the pulmonary complications due to silicon implants, described in literature are acute like acute pneumonitis or diffuse alveolar damage and only few case reports are available for chronic pulmonary pathology like Granulomatous pneumonitis and progressive massive fibrosis2, 3.Recognition of acute and chronic complications is important as treatment of chronic complications is limited. Reference #1: Narins RS, Beer K. Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg. 2006;118(3 suppl):77S–84S. Reference #2: Chastre J, Basset F, Viau F, et al. Acute pneumonitis after subcutaneous injections of silicone in transsexual men. N Engl J Med. 1983;308(13):764–767. Reference #3: Clark RF, Cantrell FL, Pacal A, et al. Subcutaneous silicone injection leading to multi-system organ failure. Clin Toxicol (Phila). 2008;46(9):834–837. DISCLOSURES: No relevant relationships by Dipen Kadaria, source=Web Response No relevant relationships by Adnan Khan, source=Web Response No relevant relationships by Anthony Mattox, source=Web Response No relevant relationships by April McDonald, source=Web Response

Establishment of novel meniscal scaffold structures using polyglycolic and poly-l-lactic acids.

The purpose of this study was to evaluate various types of meniscus scaffolds that mimic the meniscus structure, and to establish a novel cell-free meniscus scaffold with polyglycolic acid or poly-l-lactic acid. Four types of scaffolds were implanted into Japanese white rabbits: poly-l-lactic acid sponge poly-l-lactic acid, PGA-coated PLLA sponge, PGA lamination, and film-coated PGA lamination. Samples were harvested at 8 and 12 weeks after implantation, and a compression stress test was performed. The meniscus size and Ishida scores were evaluated for regenerated tissue. Immunohistochemistry was analyzed by anti-type I, II and X collagen antibodies to investigate the structure of the regenerated tissue, and by anti-iNOS antibody to investigate the inflammatory tissue of the meniscus. The cell nuclei of lymphocytes and foreign body multinucleated giant cells were counted in hematoxylin and eosin staining. Modified Mankin scores for cartilage degeneration were used for assessment after Safranin-O/Fast Green staining. The biomechanical test showed that l- and film-coated PGA lamination exhibited greater strength than s- and PGA-coated PLLA sponge. At 12 weeks, the size of meniscus and the Ishida score in implanted film-coated PGA lamination were improved significantly compared with the defect groups. The type II collagen staining intensity in the PGA lamination lamination is significantly higher than the defect at eight weeks. The staining intensity of iNOS and number of lymphocytes significantly increased in sponge poly-l-lactic acid at eight weeks, and increased in p-PLLA at 12 weeks. Foreign body multinucleated giant cells in implantation groups appeared, especially at eight weeks. The Mankin score for film-coated PGA lamination was significantly lower than for the defect at 12 weeks. Novel meniscal scaffolds especially PGA should possess not only biological but also biomechanical functions. In conclusions, film-coated PGA lamination was the beneficial property for meniscus scaffold from the points of better biomechanical function, good regeneration, and less inflammation with chondroprotective effects.

Novel grooved substrata stimulate macrophage fusion, CCL2 and MMP-9 secretion.

Rough surface topographies on implants attract macrophages but the influence of topography on macrophage fusion to produce multinucleated giant cells (MGC) and foreign body giant cells (FBGC) is unclear. Two rough novel grooved substrata, G1 and G2, fabricated by anisotropic etching of Silicon <110> crystals without the use of photolithographic patterning, and a control smooth surface (Pol) were produced and replicated in epoxy. The surfaces were compared for their effects on RAW264.7 macrophage morphology, gene expression, cyto/chemokine secretion, and fusion for one and five days. Macrophages on grooved surfaces exhibited an elongated morphology similar to M2 macrophages and increased cell alignment with surface directionality, roughness and cell culture time. Up-regulated expression of macrophage chemoattractants at gene and protein level was observed on both grooved surfaces relative to Pol. Grooved surfaces showed time-dependent increase in soluble mediators involved in cell fusion, CCL2 and MMP-9, and an increased proportion of multinucleated cells at Day 5. Collectively, this study demonstrated that a rough surface with surface directionality produced changes in macrophage shape and macrophage attractant chemokines and soluble mediators involved in cell fusion. These in vitro results suggest a possible explanation for the observed accumulation of macrophages and MGCs on rough surfaced implants in vivo. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2243-2254, 2016.

Pathology of emphysematous reticulitis in cattle: report of two cases and comparative overview of similar or identical conditions

Inflammatory forestomach disorders other than those of viral, bacterial, mycotic, parasitic, chemical, or plant poisoning origin are uncommon in the bovine species. Spontaneous focal emphysematous lesions were grossly identified in the reticulum—the second part of the forestomach—of two adult Holstein-Friesian cattle (one 2-year-old steer, the other 3-year-old dairy cow). Both cattle, which appeared to be clinically normal without evidence of apparent forestomach dysfunction or other significant abnormalities on physical examination, were slaughtered conventionally for human consumption. At postmortem inspection of these two cattle, the reticulum wall showed focal spongy areas due to the occurrence of numerous minute gas bubbles (<1.0 mm in diameter). On histopathology, this emphysematous lesion was characterized by the presence of multicystic emphysematous lymphangiectasis in the submucosa. Affected lymphatics were prominently inflamed, being infiltrated to a significant degree with eosinophils and granulomas consisting of macrophages and multinucleated foreign-body giant cells in the lumen. Submucosal connective tissues surrounding the areas of lesional lymphatics exhibited varying degrees of cellular infiltrates, including eosinophils, mast cells, macrophages, plasma cells, and lymphocytes. Additionally, edema, hemorrhage, fibrin-clot formation, or collagen fiber deposition was observed throughout the lesional submucosa. There was no evidence of bacterial, mycotic, protozoal, or parasitic infection elsewhere in the lesions. Although the precise cause and pathogenesis of this emphysematous reticulitis remain unknown, there was the likelihood that a hypersensitivity reaction might have played a certain role in the development and progression of the lesions. Histopathological features of the reticulum were consistent in many respects with those documented previously in a bovine condition referred to as emphysematous eosinophilic lymphangitis in the ruminal submucosa. From the viewpoint of comparative pathology, this article provides a brief overview of similar or identical conditions involving other organs, which have previously been described in human beings and animals.

Biocompatibilità e durata in vivo di cinque nuovi polimeri sintetici testati su coniglio

SUMMARYAlloplastic materials are frequently used in facial plastic surgeries such as rhinoplasty and nasal reconstruction. Unfortunately, the ideal alloplastic material has not been found. This experimental study evaluates the tissue response and durability of five novel polymers developed as an alloplastic material. In this experimental study involving a tertiary university hospital, six subcuticular pockets were formed at the back of 10 rabbits for the implantation of each polymer and sham group. Each pocket was excised with its adjacent tissue after three months, and collected for histopathological examination. Semi-quantitative examination including neovascularisation, inflammation, fibrosis, abscess formation, multinucleated foreign body giant cells was performed, and integrity of polymer was evaluated. A statistical comparison was performed. No statically significant difference was detected in neovascularisation, inflammation, fibrosis, abscess formation and multinucleated foreign body giant cells when a paired comparison between sham and polymer II, III and IV groups was performed individually. Nevertheless, the degree of fibrosis was less than sham group in polymer I (p = .027) and V (p = .018), although the other variables were almost similar. The integrity of polymers III (9 intact, 1 fragmented) and IV (8 intact, 2 absent) was better than the other polymers. These novel synthetic polymers could be considered as good candidates for clinical applicability. All polymers provided satisfactory results in terms of tissue response; however, fibrovascular integration was higher in polymers II, III and IV. In addition, the durability of polymer III and IV was better than the others.