Foreign Body Giant Cell Reaction Research Articles

PERITONEAL KERATIN GRANULOMAS MIMICKING PERITONEAL CARCINOMATOSIS: A POTENTIAL DIAGNOSTIC PITFALL

Abstract Introduction/Objective Keratin granulomas from a primary uterine cancer can present as peritoneal tumor nodules, mimicking peritoneal carcinomatosis. Endometrial adenocarcinomas with viable peritoneal tumor implants and/or involvement of bladder or bowel mucosa are categorized as stage IV disease. We present a rare case of endometrial adenocarcinoma of the uterus with squamous differentiation and multiple peritoneal nodules of keratin granulomas, masquerading as peritoneal carcinomatosis. Methods/Case Report A 68-year-old female with insignificant past medical history presented with complaints of postmenopausal bleeding for the past four months. Physical examination was unremarkable. Transvaginal ultrasound showed a 4.9 cm echogenic mass in the uterus. The endometrial biopsy showed squamous debris with atypical cells suspicious of malignancy. Endometrial curettings revealed endometrial adenocarcinoma, endometrioid type with squamous differentiation, FIGO Grade 1. Subsequently, she underwent hysterectomy with bilateral salpingo- oophorectomy. Intraoperatively, multiple suspicious nodules on the sigmoid colon and in the pelvis were identified, of which excisional biopsies and pelvic peritoneal washing were taken. Microscopic examination of the resection confirmed endometrial adenocarcinoma, FIGO Grade 1, nuclear grade 1, with extensive foreign body giant cell reaction to dead squamous cells (ghost cells). Cytologic examination of the peritoneal washing was unremarkable and excisions of the sigmoid serosal and peritoneal nodules showed pink eosinophilic laminated nodules surrounded by inflammatory cells including plasma cells, lymphocytes and multinucleated giant cells without any viable tumor cells. Results (if a Case Study enter NA) NA Conclusion Keratin granulomas are a foreign body reaction to keratin deposition from the squamous component of endometrioid adenocarcinoma. The pathogenesis of this foreign body response to keratin is considered to be a trans- tubal spread of keratin through retrograde shedding from the fallopian tubes. In the absence of viable tumor cells, it appears to have no negative prognostic significance. Careful microscopic examination of peritoneal keratin granulomas is imperative to avoid erroneous upstaging of the tumor and the subsequent advanced treatment.

Rectal Schistosomiasis and Adenocarcinoma

Abstract Introduction/Objective Schistosoma infestation has been implicated by the International Agency for Research on Cancer as an etiology for several cancers such as colon, liver, and bladder. S. japonicum is classified as a probable carcinogen in humans (class 2B). These trematodes may cause chronic infection in the affected organ leading to the trend of “inflammation-adenoma-carcinoma”. There is rising evidence that infection with Schistosoma japonicum is correlated with the liver and colorectal carcinoma in endemic Asian countries. We herein present a case of rectal adenocarcinoma associated with Schistosoma as a possible causal factor. Methods/Case Report An 88-year-old-woman from China, currently living in United States for past six years, presented with rectal bleeding. Colonoscopy showed evidence of a rectosigmoid mass 2.2 x 1.0 x 0.3 cm. She underwent trans-anal excision of the tumor. Microscopic examination showed moderately differentiated adenocarcinoma with tumor invading the muscularis propria (pT2). There were numerous oval / round calcified eggs (30 - 46 microns) with minute subterminal or no spine morphologically consistent with Schistosoma japonicum associated with granulomatous and foreign body giant cell reaction, fibrosis, and tissue eosinophilia. She was treated with Praziquantel and is currently undergoing endoscopic surveillance for recurrence. Results (if a Case Study enter NA) N/A Conclusion Patients with chronic Schistosoma japonicum infection have 3 times increased risk of developing colorectal cancer than those with no previous exposure to schistosomal infection. We believe that chronic S. japonicum infection is the likely etiology of rectal cancer in our patient. Physicians should be aware of such associations, especially for immigrants from endemic areas, to facilitate accurate diagnosis and management.

Cholesterol granuloma of the maxillary sinus: a case report

BackgroundCholesterol granuloma is not a common entity in the paranasal sinuses. It is a foreign body reaction to the cholesterol crystal deposition. Mostly associated with chronic middle ear diseases.Case presentationThis article reports a case of cholesterol granuloma in the maxillary sinus. A 23-year-old Asian man presented with cough, nasal obstruction, and postnasal discharge. On endoscopy, there was a mass protruding from the right maxillary ostium. On computed tomograpy imaging, there was a polypoidal mass in the right maxillary sinus. Endoscopic sinus surgery was performed, the cholesterol granuloma was removed from the right maxillary sinus, and the tissue was submitted for histopathological examination, which showed foreign body giant cell reaction to cholesterol crystals.ConclusionCholesterol granuloma of maxillary sinus is not common and often missed by clinicians. It is necessary to consider the cholesterol granuloma of maxillary sinus in the differential diagnosis sinonasal lesions. Histopathological analysis is required for confirmation and should be removed surgically. This case may help as a reference for clinician to approach these kinds of cases.

Diagnostic dilemma: axillary cysticercosis masquerading as breast mass

Cysticercosis, caused by the tapeworm Taenia solium, is a significant public health concern, particularly prevalent in developing nations. We present a case of isolated cysticercosis in the axillary region, mimicking a breast mass, in a 47-year-old woman who presented with a gradually enlarging mass in her right axilla and was initially diagnosed with fibroadenoma. However, further investigations revealed cysticercosis in the larvae, including ultrasonography and fine-needle aspiration cytology (FNAC). The patient underwent surgical excision of the cysts following a two-week course of albendazole therapy. Histopathological examination confirmed cysticercosis with a foreign body giant cell reaction. Cysticercosis typically involves muscular and subcutaneous tissues, posing diagnostic challenges due to its resemblance to other conditions. Ultrasonography, FNAC, and MRI play crucial roles in accurate diagnosis. Treatment involves a combination of surgical removal and antiparasitic medications such as albendazole. This case highlights the importance of considering cysticercosis in differential diagnosis, especially in endemic regions, and underscores the effectiveness of a comprehensive treatment approach integrating medical therapy and surgical intervention. Effective management ensures the eradication of parasitic infection and the alleviation of associated symptoms, exemplifying patient-cantered care for optimal outcomes. Increased awareness, preventive measures, and early diagnosis are essential for mitigating the burden of cysticercosis, particularly in regions with poor sanitation and high prevalence rates.

Lentil aspiration pneumonitis

This patient has a complex medical history that includes intellectual disability, blindness, deafness, seizure disorder, tracheomalacia, and recurrent aspiration. He had a percutaneous endoscopic gastrostomy in place for tube feeding. He again presented with acute respiratory distress, hypoxemia, fever, and leukocytosis. Chest computed tomography (CT) revealed bilateral infiltrates and nodular densities. A previous chest CT done 6 years prior to admission revealed multiple micronodules scattered throughout both lung fields. The patient had had a previous lung biopsy 20 years prior to admission which revealed lentil starch material in bronchioles and multifocal foreign body giant cell reactions. The patient was treated with an empiric antibiotic regimen and improved. This case demonstrates the radiographic and histologic changes associated with lentil pneumonia which is an unusual type of aspiration pneumonia. Keywords: Lentil pneumonia, granulomas, aspiration, nodules

Itaconate and citrate releasing polymer attenuates foreign body response in biofabricated cardiac patches

Application of cardiac patches to the heart surface can be undertaken to provide support and facilitate regeneration of the damaged cardiac tissue following ischemic injury. Biomaterial composition is an important consideration in the design of cardiac patch materials as it governs host response to ultimately prevent the undesirable fibrotic response. Here, we investigate a novel patch material, poly (itaconate-co-citrate-co-octanediol) (PICO), in the context of cardiac implantation. Citric acid (CA) and itaconic acid (ITA), the molecular components of PICO, provided a level of protection for cardiac cells during ischemic reperfusion injury in vitro. Biofabricated PICO patches were shown to degrade in accelerated and hydrolytic conditions, with CA and ITA being released upon degradation. Furthermore, the host response to PICO patches after implantation on rat epicardium in vivo was explored and compared to two biocompatible cardiac patch materials, poly (octamethylene (anhydride) citrate) (POMaC) and poly (ethylene glycol) diacrylate (PEGDA). PICO patches resulted in less macrophage infiltration and lower foreign body giant cell reaction compared to the other materials, with corresponding reduction in smooth muscle actin-positive vessel infiltration into the implant region. Overall, this work demonstrates that PICO patches release CA and ITA upon degradation, both of which demonstrate cardioprotective effects on cardiac cells after ischemic injury, and that PICO patches generate a reduced inflammatory response upon implantation to the heart compared to other materials, signifying promise for use in cardiac patch applications.

Chronic tophaceous gout – A case report

Gout is an inflammatory arthritis associated with functional impairment and impact on quality of life. It arises when the tissues are supersaturated with urate leading to the formation of mono sodium urate crystals in and around the joints. This causes an inflammatory cascade resulting in secretion of several proinflammatory cytokines and neutrophil recruitment into the joint.A 60 years old male patient presented with complaints of swelling in the posterior aspect of left elbow since 2 years and pain since 15 days. Examination revealed soft tissue swellings in multiple joints including metatarsophalangeal joint. Renal function tests show increased Uric acid (8.6mg/dl). On Gross examination, we received fibrofatty mass measuring 3.5x1.5x1 cm. Cut-section showed white flakes ? Calcifications. On microscopy, sections studied show fibrocollagenous tissue with several tophi made up of pink eosinophilic material surrounded by foreign body giant cell reaction and lymphocytes. There are several cystic spaces filled with calcareous debris.Hyperuricemia is the key risk factor for gout and is considered prerequisite for mono sodium urate crystal formation. Urate under excretion through kidney is the major mechanism for hyperuricemia. Tophus formation is the cardinal feature of advanced gout.

Safety of the injectable expanding biopolymer foam for non-compressible truncal bleeding in swine

BackgroundA novel hydrophobically modified chitosan (hm-chitosan) polymer has been previously shown to improve survival in a non-compressible intra-abdominal bleeding model in swine. We performed a 28-day survival study to evaluate the safety of the hm-chitosan polymer in swine. MethodsFemale Yorkshire swine (40–50 kg) were used. A mild, non-compressible, closed-cavity bleeding model was created with splenic transection. The hm-chitosan polymer was applied intra-abdominally through an umbilical nozzle in the same composition and dose previously shown to improve survival. Animals were monitored intraoperatively and followed 28 days postoperatively for survival, signs of pain, and end-organ function. Gross pathological and microscopic evaluations were performed at the conclusion of the experiment. ResultsA total of 10 animals were included (hm-chitosan = 8; control = 2). The 2 control animals survived through 28 days, and 7 of the 8 animals from the hm-chitosan group survived without any adverse events. One animal from the hm-chitosan group required early termination of the study for signs of pain, and superficial colonic ulcers were found on autopsy. Laboratory tests showed no signs of end-organ dysfunction after exposure to hm-chitosan after 28 days. On gross pathological examination, small (<0.5 cm) peritoneal nodules were noticed in the hm-chitosan group, which were consistent with giant-cell foreign body reaction in microscopy, presumably related to polymer remnants. Microscopically, no signs of systemic polymer embolization or thrombosis were noticed. ConclusionProlonged intraperitoneal exposure to the hm-chitosan polymer was tolerated without any adverse event in the majority of animals. In the single animal that required early termination, the material did not appear to be associated with end-organ dysfunction in swine. Superficial colonic ulcers that would require surgical repair were identified in 1 out of 8 animals exposed to hm-chitosan.

A study of the histopathology of collagen fleece (TachoSil) patching of tunica albuginea in the rat penis and a literature review of penile graft materials in experimental animals.

A penile tunica defect may arise during surgery in patients with Peyronie's disease. Collagen fleece (TachoSil) has recently gained popularity in penile surgery to cover the tunica albuginea (TA) defect associated with clinical success. However, it is not known what the histological outcomes of these grafts are in the penis. We aimed to study the histopathology of the TachoSil graft in an experimental animal model for the regeneration of TA, inflammation, fibrosis, and the underlying cavernous tissue. Six adult male Sprague Dawley rats were used. The penis was degloved through a circumferential subcoronal incision. A longitudinal 1 mm × 10 mm defect was created at the base of the lateral aspect of the penis. A TachoSil patch (Takeda, Japan) was applied to the defect. The penile skin covering was then restored. At 2 months, the rat penis was excised and examined with hematoxylin, eosin, and trichrome stains. We conducted a literature review of penile grafts in animals for comparison. Rats weighed 369.2 gm (standard deviation: 31.5). At 2 months, all rats showed normal-looking penis with complete healing, no scaring, tethering, or gross inflammatory features. Histopathology of the patch site showed fibrosis, chronic inflammation, and foreign body giant cell reaction. There was no generation of a new TA, or new vascularity. No inflammatory or pathological reaction affected the underlying corpus cavernous tissue. One rat died on the 6th postoperative day. Postmortem showed massive multiorgan hemorrhage consistent with disseminated intravascular coagulopathy (DIC). Unlike some other reported grafts, there is no TA regeneration. TachoSil patching of penile TA defect forms a distinctive barrier against inflammation, protecting the underlying corpus cavernosum. However, no regeneration of the tunica defect is observed at 2 months. DIC is a potential complication of systemic absorption of TachoSil.

Histopathological changes in tissues surrounding vagal nerve stimulation generators: A retrospective analysis of revision surgeries.

Vagal nerve stimulation (VNS) is an effective treatment for patients with epilepsy, depression, and other neuropsychiatric conditions. Understanding the tissue changes associated with VNS devices is crucial for optimizing patient outcomes and device development. This study aimed to investigate the histopathological changes in the tissues surrounding the VNS generator and explore potential correlations with clinical factors and battery performance. A total of 23 patients who underwent VNS generator revision surgery owing to battery depletion were included. Tissue samples from the areas surrounding the VNS generator were obtained and analyzed for histopathological changes. Demographic and device-related variables were also recorded. Capsule formation was observed in all patients. Acute inflammation were not detected in any case. Perivascular lymphocytic infiltration, foreign-body giant cell reaction (FBGCR), and calcification were observed in 8.7%, 26.1%, and 43.5% of patients, respectively. Crystalloid foreign body appearance was noted in 4 patients. The median output current of the generator was higher in patients with lymphocytic infiltration than in those without lymphocytic infiltration. The median off time was higher in patients with skin retraction than in those without skin retraction. Moreover, discomfort was associated with the presence of FBGCR. Our study provides insights into the tissue changes associated with the VNS generator, with capsule formation being a common response. Crystalloid foreign body appearance was not reported previously. Further research is needed to understand the relationship between these tissue changes and VNS device performance, including the potential impact on battery life. These findings may contribute to VNS therapy optimization and device development.

A Curious Case of Omental Oxalate Crystals in a Patient With Struma Ovarii: Pointers to an Unusual Clinicopathological Scenario.

Percutaneous image-guided biopsies are becoming increasingly common in routine pathology practice, with the greater omentum emerging as a common target. We present herein an account of a middle-aged lady with a complex ovarian mass, omental thickening, and raised serum CA125; clinically suspected to have advanced ovarian malignancy. Fine needle aspiration cytology (FNAC) from the ovarian mass was inconclusive. Omental biopsy revealed only refractile, birefringent crystalline material with surrounding foreign body giant cell reaction; thus surprising the clinical team. Subsequent resection of the ovarian mass showed a teratoma composed exclusively of thyroid tissue, diagnosed as struma ovarii. The omental crystals, interpreted as calcium oxalate crystals, were possibly a consequence of colloid seeding during the ovarian mass FNAC.

(112) An Experimental Animal Study of the Histopathological Effect of Collagen Fleece (TachoSil) Patch of Tunica Albuginea Defects Associated with Penile Surgery

Abstract Introduction A penile tunica defect may arise during penile prosthesis surgery or reconstruction of the penis in patients with Peyronie’s disease. Collagen fleece (TachoSil) was recently reported in penile surgery to cover the tunica defect with reported clinical success. However, it is not known what the histological outcomes of these grafts are in the penis. Objective We study the novel application of TachoSil graft in an experimental animal model. We looked at the regeneration of tunica albuginea, development of inflammation and fibrosis, and histopathological effect on the underlying cavernous tissue. Methods Seven adult male Sprague Dawley rats were used. All procedures were carried out under general inhalation anesthesia. The penis was degloved through a circumferential subcoronal incision. A longitudinal 1x10 mm defect was created at the base of the lateral aspect of the penis. A TachoSil patch (Takeda, Japan) was applied to the defect in six rats and Surgicel (Ethicon) in one. The penile skin covering is then restored and fixed with interrupted 5-6 zero absorbable sutures. At two months, the rat penis was evaluated for excision. Euthanasia was carried out with an overdose of inhalation anesthesia and chest opening. The excised penis was examined by hematoxylin and eosin and trichrome stains. Results At the time of surgery, the rats’ weight was 390 gm (SD 33.8). All rats with TachoSil showed normal-looking penis at two months with complete healing, no scaring, tethering, or gross inflammatory features. The penis of three rats with a Tachosil patch was harvested at two months postoperatively. It showed histopathology of fibrosis, chronic inflammation, and foreign body giant cell reaction at the site of the patch. There was no generation of a new tunica albuginea, no new vascularity or distinct fibrous layer development. The underlying corpus cavernous tissue was not affected by any inflammatory or pathological reaction. One rat died on the 6th postoperative day. Postmortem showed massive gastrointestinal bleeding, intraperitoneal hemorrhage, and punctate hemorrhages of the parenchyma of both suprarenal glands, both kidneys, and the liver. A clinical diagnosis of DIC was made. Histopathology of the penis, however, did not show micro thrombosis. The fifth rat with a Surgicel patch showed immediate hematoma of the penis controlled by compression. After two months, during harvesting of the penis, large pockets of pus were seen spreading from the site of the patch to surrounding structures. Histopathology showed chronic inflammation and fibrosis extending into the corpus cavernosum. The sixth and seventh rats showed normal penis external appearance at two months and were left surviving for harvest at four months. Conclusions Tachosil patching of penile tunica albuginea defect forms a distinctive barrier against inflammation protecting the underlying corpus cavernosum. However, no regeneration of tunica defect is observed at two months. DIC is a potential complication of systemic absorption of TachoSil. Disclosure No

Epidermoid Cyst: An Esthetic Challenge, If Neglected-A Comprehensive Analysis of 217 Cases.

An epidermoid cyst is a benign keratin-filled cyst, commonly located in the face, scalp, neck, and trunk. Although it is a common benign cystic neoplasm, large series of analyses in English literature are still scarce. To comprehend the clinical and pathological variation of epidermoid cysts in the sub-Himalayan region of India, as well as their clinical implications for late diagnosis, a retrospective study on epidermoid cysts was conducted. This was a retrospective observational study conducted on 217 cases of epidermoid cyst subjected for fine-needle aspiration cytology over a period of 3.6 years (from 2018 to 2021). The clinical details and other epidemiological data were archived from the pathology requisition forms. It showed slight male preponderance with head and neck site as the most common area. Most patients were adults. Few uncommon sites were also seen namely breast, parotid, epididymis, and tonsils. Few large lesions were identified measuring up to 10 cm. The skin changes were seen in 5.5% cases, 0.9% cases show extreme ulceration, and 4.1% cases show foreign body giant cell reactions. Due to the province's steep terrain and limited access to medical services, the majority of patients arrived at out patient department (OPD) late. The findings suggest that fine-needle aspiration can be used as a quick diagnostic test even in remote areas by the general practitioner who can send the slides for evaluation to a pathologist. Many times, clinically looking epidermoid cyst can reveal certain challenging entities such as a biphasic fibroepithelial tumor with cystic squamous metaplasia and proliferating pilar tumor in our series. The study of this lesion is also needed for early diagnosis as long-standing lesion may rupture and cause requirement of extensive treatment followed cosmetic impairment.

Cytomorphological spectrum of pilomatricoma - A series of 28 cases.

Pilomatricoma is a benign tumour that originates in the outer sheath of the hair follicle root. The clinical diagnosis of this rare entity is often missed, possibly due to a lack of awareness. Its characteristic cytomorphological features are sheets of ghost cells, basaloid cells, calcification and foreign body giant cell reaction. However, the above features may not all be present in all cases, rendering cytological diagnosis difficult. This retrospective study included all cases of pilomatricoma diagnosed on fine needle aspiration over a period of 4 years. The histopathological diagnosis was retrieved for the cases wherever possible. A detailed histopathological and cytological evaluation was performed for the various components-basaloid cells, ghost cells, calcified debris, foreign body giant cells, bare nuclei, neutrophils, and macrophages-and they were graded on a scale of 0 to 3+. The 28 cases included 8 female and 20 male patients with a mean age of 34.6 years. Most cases (22 cases; 78.6%) were located in the head and neck, with the scalp being the most common site. Twenty-five cases were cytologically diagnosed as pilomatricoma based on a variable admixture of the various components-nests of basaloid cells, ghost cells, foreign body giant cell reaction, calcified debris and viable squamous cells. However, in two cases which showed an absence of basaloid cells, a differential diagnosis of epidermal inclusion cyst was also included. Another case showed a predominance of basaloid cells with a paucity of ghost cells, so a differential diagnosis of adnexal tumour was also included. Among all the cytological parameters, sheets of ghost cells followed by nests of basaloid cells and foreign body giant cell reaction had the highest sensitivity in the cytological diagnosis of pilomatricoma. The presence of sheets of ghost cells is the most sensitive parameter for the cytological diagnosis of pilomatricoma. It is important that pilomatricoma should be considered in the differential diagnosis of subcutaneous masses, particularly in the head and neck region.

Cutaneous Rhinosporidiosis Masquerading as a Soft Tissue Tumour Diagnosed on FNAC

Background: Rhinosporidiosis refers to a granulomatous inflammation of mucocutaneous sites caused by Rhinosporidium Seeberi, presenting most frequently as polypoidal lesions in the nose and nasal cavity. Involvement of sites like the conjunctiva, trachea, nasopharynx, skin, and genitourinary tract are rare. Cases of nasal rhinosporidiosis with satellite skin nodules around head and neck region has been reported. Primary cutaneous involvement is however extremely rare [1]. We report the case of a 58 year old male who came with complaints of anterior chest wall swelling since 2 months with sudden increase in size. The patient was sent for FNAC with a clinical diagnosis of a soft tissue tumor. FNAC however revealed sporangia of varying sizes with endospores along with foreign body giant cell reaction. Histopathological examination confirmed the diagnosis. Cutaneous rhinosporidiosis may mimic a soft tissue tumor. FNAC being a minimally invasive and less expensive procedure gave a definitive diagnosis, and also aided to initiate prompt management of the condition.

Case report of 16-year-old male with tubulointerstitial nephritis with refractory uveitis in Saudi Arabia

Background: Tubulointerstitial nephritis with uveitis (TINU) syndrome is a condition characterized by uveitis with tubulointerstitial nephritis in the absence of another systemic condition. Case Presentation: We report a case of a 16-year-old boy referred to our hospital due to elevated renal function and a 7-day history of unilateral eye congestion. An ophthalmologist made the diagnosis of left eye anterior uveitis. The diagnosis of acute kidney injury was made. A renal biopsy was obtained and showed tubulointerstitial nephritis with granulomatous inflammation and foreign body giant cell reaction. The patient improved after initiating corticosteroid therapy with a tapering dose. Conclusion: TINU syndrome is a rare clinical condition that can present unusually and can be misdiagnosed. Hence, physicians should be familiar with this condition to diagnose it and start proper treatment without delay. The patient should follow up with ophthalmologists, nephrologists, and primary physicians for a better treatment outcome. The outcome is usually excellent with treatment, but some patients may have recurrent uveitis.

Clinicopathological Appraisal of Cutaneous Cysts: A 2-Year Retrospective Observational Study

Background: Cysts, primarily epidermal and trichilemmal, are commonly seen in clinical practice. Rupture, infection, inflammation, and rarely malignant transformation may complicate the cysts. This study aims to analyze the clinicohistological features of cutaneous cysts. Materials and Methods: A retrospective review of patients with the diagnosis of cyst confirmed on histopathology over the past two years (2020–2021) was performed. Clinical details comprised of age, gender, site of involvement, size, duration, and associated symptoms. Histological examination included cyst wall lining, type of keratinization, complications like rupture, inflammation, foreign body giant cell reaction, calcification, and malignant change. Results: A total of 324 cases with mean age of 37.9 years and equal gender distribution were identified. Most frequent diagnosis was epidermal cyst in 89.8%, followed by trichilemmal cyst in 8.9% of cases. Rare types included follicular hybrid cyst, verrucous cyst, vellus hair cyst, and steatocystoma. Most common complication was cyst rupture in 54.3% of epidermal cysts. Proliferating epidermal and proliferating trichilemmal cysts were noted in one and two cases, respectively. Two cases revealed malignancy arising in the wall of epidermal cyst. Limitations: The retrospective study design and non-availability of follow-up data, especially for proliferating cysts and cysts with malignant transformation were the main limitations of this study. Conclusion: Histopathologic examination of excised cutaneous cysts is paramount in reaching accurate diagnosis of the type of cyst and associated secondary changes to enable appropriate management.

Pseudotumor Associated with a Bioabsorbable Screw in a Patient with Reconstructed Congenital Absence of the Anterior Cruciate Ligament: a Case report

Congenital absence of the anterior cruciate ligament (ACL) is an extremely rare condition associated with a wide spectrum of malformation. Here we describe a rare complication in a patient with congenital absence of the ACL after ACL reconstruction using a bioabsorbable screw. A 35- year-old woman presented a right knee mass that had been slowly growing for several months. Five years previously, she experienced acute right knee pain, locking, and instability after hiking. Images and diagnostic arthroscopy at that time revealed an absence of the anterior cruciate ligament, a hypoplastic lateral distal femoral condyle, a stenotic intercondylar notch, and hypoplastic posterior cruciate ligament along with a bucket handle tear of the medial meniscus. A right anterior cruciate ligament reconstruction was performed, and she did well for the next five years without knee joint instability until she presented a mildly painful subcutaneous pretibial soft tissue mass. Imaging studies demonstrated a 2.4 cm subcutaneous lobulated soft tissue mass protruding from the expanded tibial tunnel. The mass was excised, and the histology showed a solid and cystic lesion composed of a histiocytic and foreign body giant cell reaction to the degraded polymer along with spheres of calcium phosphate particles. At a two-year follow-up after debridement, the patient reported an overall improvement without any knee instability or local recurrence. To the best of our knowledge, this is the first report of a pseudotumor developed after ACL reconstruction in a patient with a congenital absence of the ACL.

Pelvic Cholelithiasis. A Report of 4 Cases

Abstract Introduction/Objective Spillage of gallstones in the peritoneal cavity during laparoscopic cholecystectomy is a known intraoperative complication which could cause peritoneal irritation/abscess and occasionally present as ovarian cholelithiasis and pelvic mass. Our aim is to present the clinicopathologic findings of pelvic cholelithiasis in our institution. Methods/Case Report A one year computerized natural language search for “Halls, bile, pigment, crystals” in surgical final diagnosis and comment was performed. The patients’ demographic, clinical presentation &amp; history of cholecystectomy were collected from the medical records. The pathologic findings were reviewed. Results (if a Case Study enter NA) We identified 4 women with an age range of 45-52 (mean=50). Three patients presented with abnormal uterine bleeding and one patient was admitted for sterilization. The time interval from cholecystectomy was 3-26 years (mean=18).Intra-operative findings were as follows: Case 1: blue-black 5 mm lesion located in the right ovary, Case 2: yellow-surface nodularity of left ovary and &amp;lt;1 cm white lesion in posterior cul- de sac, Case 3 two left ovarian cysts (0.8 and 1.5 cm), and Case 4 for sterilization showed a 0.3 cm. brown peritoneal lesion and unremarkable fallopian tubes. The histologic findings revealed bile pigment/crystals overlying the surfaces of the ovaries (3) peritoneum (1), &amp; pelvis (1) with fibrosis and foreign-body giant cell reaction. The pathologic diagnosis was made in conjunction with prior history of cholecystectomy. Halls bilirubin stain was positive in 2/2 cases. Conclusion Pelvic cholelithiasis is an incidental finding in pre and post-menopausal women often involving the ovaries, peritoneum and pelvis. Intra-operatively, it could mimic endometriosis and pelvic mass. Histologic findings show bile pigment/crystals on serosal surface with fibrosis and foreign-body giant cell reaction. Familiarity with the histologic findings in conjunction with history of cholecystectomy is helpful in arriving at the correct diagnosis.

Cryptococcus Infection Mimicking Lipoid Pneumonia in a Lung Biopsy

Abstract Introduction/Objective Lipoid pneumonia is a non-infectious, rare entity which results from accumulation of exogenous or endogenous lipids in the lungs. It appears as intraalveolar macrophages filled with lipids in the form of fine spherical vacuoles. Cryptococcosis can also appear as vacuolated macrophages filled with yeasts. At low magnification, the distinction is very difficult. The co-existence of the two entities is noted in literature but is exceedingly rare. Methods/Case Report A 33-year-old male, status post renal and pancreatic transplant, on chronic immunosuppression therapy presented with dysphagia. Imaging studies showed cavitary and non-cavitary nodules, patchy, confluent consolidations in the bilateral lungs, and a patulous, debris filled esophagus. This raised the possibility of atypical infections as well as aspiration. Biopsy of a right lower lobe lung lesion was performed. Histology demonstrated fibrotic lung parenchyma with vacuolated histiocytes containing small spherical substances. The differential diagnosis included Cryptococcus infection versus exogenous lipoid pneumonia, both of which were consistent with clinical and radiologic findings. Few, scattered foreign body giant cells were found. Additionally, GMS and mucicarmine stains were positive in the small spheres within the macrophages. The final diagnosis of lung parenchyma with numerous yeast forms, morphologically consistent with cryptococcus species was rendered. The patient was additionally found to have esophageal candidiasis. Concurrent lipoid pneumonia was considered unlikely based on the patient's history of immunosuppression (which made infection a much more likely etiology) and paucity of foreign body giant cell reaction. Results (if a Case Study enter NA) NA Conclusion This case highlights the importance of knowledge of rare entities and correlation with clinical and radiologic findings in arriving at an accurate diagnosis.