Foreign Body Giant Cell Reaction Research Articles

Scrotal Calcinosis mimicking malignancy - A rare case presentation

Scrotal calcinosis is a rare benign disease, which presents as multiple, painless, hard nodular growth in the scrotum without any systemic metabolic disorder. Histologic features of the lesion are extensive dermal deposits of calcium, with associated lympho-histiocytic aggregates and focal foreign body giant cell reaction. The pathogenetic mechanisms could be either purely idiopathic or any form of dystrophic calcification of the lining epithelial cysts or any inflammatory process with subsequent rupture, calcification and obliteration of the cyst wall. We present a rare case report of a 23-year-old male, who presented to the general surgery clinic with complaints of multiple, firm to hard scrotal swellings for the last 6 months. Microscopic examination of the excised growth showed multiple cysts with foci of normal and inflamed lining, with luminal calcific material with foci of ‘naked’ calcium deposits in the dermis. Biochemical tests showed normal values of serum calcium and phosphorus levels in our patient.

Changes in platelet-rich fibrin composition after trauma and surgical intervention

Reconstruction surgery after trauma has always been a big challenge. The use of platelet-rich fibrin (PRF) as an autologous source could help accelerate the regeneration time of bone and soft tissues. PRF is a blood concentrate system obtained through a one-step centrifugation. The 3D matrix of the PRF clot serves as a reservoir of growth factors. In the present study, PRF from patients after trauma and after surgery was compared to healthy volunteers to evaluate the composition and potential of PRF as a possible autologous tool for growth factor delivering. Two PRF species and blood from healthy volunteers and patients after trauma and after following surgical intervention were compared (n = 10). FACS analysis, ELISA, and histological analysis were performed. The Pro-inflammatory potential after trauma and after the intervention is increased in PRF species whereas cellular and humoral factors with distinct regenerative potential remained on a level comparable to peripheral blood. It was demonstrated that cells in PRF express more pro-inflammatory species when obtained after the surgical intervention compared to PRF from healthy individuals. This pro-inflammatory potential should be considered, when combining PRF with bone substitute materials for reconstruction surgery prone to foreign body giant cell reaction. Accordingly, solid or injectable PRF-based matrices should preferably be prepared prior to a surgical intervention.

Ulcerative nodules on the entire body

Ulcerative nodules on the entire body

Tumoral calcinosis simulating sarcoma

Tumoral calcinosis is a rare clinical and pathological entity, characterized by deposition of calcium in different sites of human body particularly in peri-articular tissues. It incidence is usually seen in young adults as a slowly growing, painless, firm to bony hard mass. Asymptomatic when small in size but larger masses can cause pressure symptoms due to compression of surrounding tissues or restriction of mobility of the joints. It can be predicted by typical radiological findings with the help of serum calcium and phosphorus levels but is confirmed only by histopathological examination. Many times, it isn’t very easy to diagnose this condition preoperatively and can be mistaken as soft tissue sarcoma both clinically and radiologically. Subtyping of this lesion depends on serum calcium, phosphorus levels, family history and co-morbid conditions like chronic renal failure. Hemodialysis, hypervitaminosis-D, milk-alkali syndrome, hyperparathyroidism, etc are responsible for the secondary causes. Treatment modality depends on the subtype, which can be medical or by surgical intervention. The present study was a case of adolescent male with a slowly growing swelling over the right hip region for 4 years. There was no traumatic history or any significant family history. Serum calcium and phosphorus levels were within normal limits. Radiology showed well-demarcated lobulated solid-cystic mass swelling measuring 7.8x3.9x3.5cm suggestive of sarcoma. The tumor was excised and sent for histopathological examination. Grossly, it was a ovoid solid-cystic firm to hard mass, microscopy showed large areas of dystrophic calcification with cystic spaces surrounded by foreign body giant cell reaction. Correlating with history, clinical findings, biochemical findings, the diagnosis of primary normophosphatemic tumoral calcinosis was made.

Characterization of Novel Injectable Lifting Agents Used in Colonic Polyp Removal: An Emerging Amyloid Mimic.

Colon polypectomy can require an injection of a submucosal lifting agent to fully visualize and completely remove the polyp. To the best of our knowledge, this is the largest morphologic series on the novel lifting agents Eleview and Orise. The study consisted of 1 polypectomy and 8 colon resections from 9 patients: 6 women, 3 men (mean age=64 y); Orise=6, Eleview=3; the median time interval between injection and resection=16 weeks. Pathologic diagnoses of the polyps included tubular adenoma (n=4), tubulovillous adenoma (n=4), and sessile serrated adenoma/polyp (n=1). We report that a histologically processed Orise aliquot from the manufacturer showed similar histology to that seen in the specimens from patients with confirmed Orise injection. The morphology of the agents in the patient specimens changed with time status postinjection: immediate resection of the lifting agent showed basophilic, amorphous, and bubbly-extracellular material with prominent hemorrhage, and resection ∼3 months after lifting agent injection showed prominent hyalinized, pink-amorphous ribbons and globules with a foreign body giant cell reaction and fibrosis. The epicenter of the lifting agents was in the submucosa, and the agents were neither refractile nor polarizable. Because of the morphologic overlap with amyloid, 5 cases were stained with Congo Red, and all cases were negative. In conclusion, awareness of the morphology of these new lifting agents is important for accurate diagnosis and to avoid the diagnostic pitfall of amyloid. These lesions can be definitively distinguished from amyloid by their nonreactivity on a Congo Red and familiarity with their characteristic clinicopathologic presentation.

"SAGE-IN-BUD": A RARE CAUSE OF TREE-IN-BUD PULMONARY INFILTRATES

SESSION TITLE: Case Report Semifinalists 3 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Tree-in-bud infiltrates on lung imaging may be caused by a number of infectious, neoplastic, congenital, and inflammatory etiologies, however is very rarely secondary to foreign body aspiration. We present a case with an unusual cause of diffuse pulmonary tree-in-bud infiltrates. CASE PRESENTATION: A 55-year-old female with a past medical history of systemic lupus erythematosus, diffuse alveolar hemorrhage, and lupus anticoagulant syndrome presented to the emergency department with a three-day history of a dry cough. A computed tomography (CT) scan of her chest revealed diffuse, uniform tree-in-bud infiltrates, involving every lobe of her lungs. The patient had a chronic, intermittent mild, dry cough, but an otherwise unremarkable review of systems. She was a never smoker and denied any other inhalation or illicit drug use. Her previous episode of diffuse alveolar hemorrhage occurred 13 months prior to this admission and had not recurred. Laboratory evaluation including complete blood count, metabolic profile, and HIV testing was unremarkable. Her vitals were normal, as were pulmonary function tests. .Bronchoscopy revealed a macrophage-predominant bronchoalveolar lavage sample, negative cultures, no acid fast bacteria, and cytology that was negative for malignancy. Transbronchial biopsies revealed extensive small airway impaction by foreign material with associated foreign-body giant cell reaction and granulomatous inflammation. Further evaluation demonstrated a positive reaction on a Periodic Acid-Schiff modification (PAS) of the foreign material. Given the histological appearance of the foreign body and positive PAS staining, forensic pathology determined that the foreign material seen on biopsy was consistent with plant material. An extensive exposure history was obtained and it was revealed that, as a part of her Native American religion, she would semi-regularly burn a bundle of white sage (Salvia apiana) leaves. While burning the bundle of white sage she would walk around her home, spreading the smoke in a ritual termed “smudging,” admittedly inhaling the smoke and particulate matter from the burning sage. DISCUSSION: Given her inhalation exposure to particulate plant matter, a paucity of other exposures, and the findings on transbronchial biopsy we believe her tree-in-bud infiltrate was secondary to her practice of “smudging.” CONCLUSIONS: To our knowledge, this is the only reported case of inhaled plant material causing an inflammatory small airway disease and a tree-in-bud infiltrates on chest imaging. Reference #1: Causes and Imaging Patterns of Tree-in-Bud Opacities. Miller, Wallace T. et al. CHEST , Volume 144 , Issue 6 , 1883 - 1892 DISCLOSURES: No relevant relationships by Vikramjit Khangoora, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 Added 03/15/2019 by Joshua Sill, source=Web Response, value=Honoraria

Jejunal Atresia Associated With Intramural Calcification in a Newborn

Abstract Objectives Jejunal atresia and associated intramural calcification are a rare phenomenon, only few cases have been reported. Jejunal atresia is an antenatal developmental defect causing intestinal obstruction in newborns. In most of the cases, the condition is diagnosed by fetal ultrasound during the period of third trimester. We are reporting a case of neonatal jejunal atresia associated with intramural calcification and extensive foreign body reaction. Methods A baby girl was born at a gestational age of 36 weeks, 4 days through spontaneous vaginal delivery with a weight of 2.99 kg. The significant maternal history was gestational diabetes. The baby was diagnosed with jejunal atresia by antenatal ultrasound and received gastric suction immediately after delivery. About 200 mL of dark green fluid was suctioned from the stomach. Postnatal x-ray demonstrated significant distension of bowel loops and stomach. The baby underwent exploratory laparotomy with congenital atresia repair. Morphologically, the proximal portion of jejunum was dilated and small portion of distal segment of jejunum appeared to have type IIIB atresia. The atretic portion was examined grossly and processed as paraffin-embedded tissue for microscopic examination. Results The atretic segment was about 1 cm long, the serosal surface demonstrated foci of hemorrhage, and the wall was thickened. Microscopically, the atretic segment and adjacent area showed chronic inflammation, extensive foreign body type giant cell reaction, and abundant intramural calcification. Conclusion Some hypothesize that intramural calcification in conjunction with foreign body giant cell reaction associated with multifactorial events including vascular insults during the prenatal period. However, there are no studies directed to elucidate the precise pathogenesis of this combination of findings in the intramural location.

Clinicopathological characteristics of ypT0N0 urothelial carcinoma following neoadjuvant chemotherapy and cystectomy

AimsTo describe a large tertiary care academic centre’s experience with patients who achieve a complete pathological response (ie, ypT0N0) following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) with emphasis on...

Histopathological changes to the vascular wall after treatment of great saphenous veins using n-butyl-2-cyanoacrylate.

Background: A histopathological examination was conducted on vein samples from six patients who had undergone great saphenous vein sealing with Histoacryl and Lipiodol to treat chronic venous insufficiency of the superficial venous system. Patients and methods: In each patient a sample of the complete vein including the surrounding tissue was obtained through a minor incision under perioperative sonographic monitoring. Each patient had signed an informed consent form. Samples were taken at the following intervals: six days, six weeks, six months, one year, two years, and three years after treatment. Results: N-butyl-2-cyanoacrylate with Lipiodol induces a thrombotic reaction in the acute phase and endothelium is destroyed but no significant inflammation or substantial vascular wall damage is present. In the subsequent period, a foreign body giant cell reaction emerges accompanied by only moderate chronic inflammation that does not extend to the vascular wall or the surrounding tissue. The thrombus is organized with minimal recanalization. The foreign material is gradually degraded, and it is no longer detectable after three years. The vessel wall showed slight sclerotization. Conclusions: N-butyl-2-cyanoacrylate that has been applied gradually degrades over the course of three years accompanied by a giant cell reaction, mild chronic inflammation and cicatrices, but there is minimal recanalization of the obturated section.

Pulmonary pathologic alterations associated with biopsy inserted hydrogel plugs

The prevention of pneumothorax after percutaneous lung biopsy is a major patient safety concern. The insertion of hydrogel plugs into biopsy sites to mitigate this complication is a new intervention. The histology of the plug has not been previously reported, and in this study the histologic reaction is reported in 13 cases. The hydrogel plug forms a spherical basophilic matrix pool with an adjacent foreign body giant cell reaction and patchy eosinophilia. No extension to the pleural surface is present. The potential diagnostic errors related to the presence of the plug are discussed.

SAT-496 Symptomatic Hypercalcemia in a Transgender Patient with Silicone-Induced Granulomas

Introduction Despite FDA-issued safety concerns, silicone injections remain legal and are practiced by unlicensed providers. Here we present a case of calcitriol-mediated hypercalcemia secondary to a granulomatous reaction induced by silicone injections. Clinical Case This is a case of a 39-year-old male to female transgender patient who presented with nonspecific symptoms that included myalgias and abdominal pain. The patient’s past medical history includes bipolar 1 disorder, well-controlled HIV, GERD, history of DVT/PE and a history of Hodgkin’s lymphoma treated with chemotherapy and autologous stem cell transplant 3 years prior to presentation. A thorough physical exam revealed infiltrative red plaques involving her buttocks and breasts at sites where, after further questioning, she reported receiving cosmetic silicone injections in Mexico as part of her gender transition 15 years ago. Laboratory evaluation revealed a serum calcium level of 13.5mg/dL (n 8.5-10.1mg/dL) and a serum creatinine level of 1.74mg/dL from a baseline creatinine of 1.1mg/dL. 1,25-dihydroxyvitamin D level was high at 92.5pg/mL (n 19.9-79.3pg/mL) while a 25-hydroxyvitamin D level was low at 16.2ng/mL (n 30-100ng/mL). PTH was undetectably low (<6.5pg/mL) and PTH-related protein level was normal at 3.4pmol/L (n<3.4pmol/L). Contrasted CT imaging of her chest, abdomen and pelvis revealed infiltrative nodular soft tissue hyperdensities throughout the breasts and buttocks likely representing a granulomatous inflammatory process. The patient was initially treated with intravenous fluids and furosemide administration. Dermatology was consulted, and biopsy of the affected plaques was performed. Patient was started on prednisone to target the exuberant 1-alpha hydroxylation thought to be occurring at the site of the granulomatous reaction. Results of the tissue biopsy revealed a foreign body giant cell reaction consistent with silicone injection. Serum calcium levels rapidly normalized after initiating steroid therapy and patient was discharged to follow-up as an outpatient where prednisone was eventually tapered off and she was started on hydroxychloroquine. Conclusion Hypercalcemia is a commonly encountered problem that is often incidentally found in patients presenting with non-specific symptoms. Clinical judgement leads us down a well-learned algorithm to attempt to diagnose the etiology. However, there is growing evidence linking silicone injections to granulomatous disease. It is therefore prudent to consider silicone granulomas as part of the differential of hypercalcemia, particularly within the transgender community. It is of vital importance to directly ask about past cosmetic injections as most patients will not readily volunteer that information.

Histological analysis of different local haemostatic agents used for periapical surgery: An experimental study with Sprague-Dawley rats.

The aim of the present study was to analyse differences in the tissue response to the different haemostatic agents used for periapical surgery (BloodSTOP iX® (oxicellulose), Expazen® (aluminum chloride), calcium sulphate (CS), Gelatamp® (gelatin sponge) and Hemocor® (ferric sulphate). Seventy-two bone defects were made on the calvarium of 36 Sprague-Dawley rats. The specimens were euthanised at 3, 6 and 12weeks. Histological analysis revealed a giant cell foreign body reaction against BloodStop iX® , Gelatamp® and Hemocor® . Leukocytes persisted at the surgical bed during the healing process longer as expected with Gelatamp® (6weeks) and Hemocor® (12weeks). We confirmed a generalised delay in bone formation. Calcium sulphate did not cause any foreign body reaction. CS showed excellent results with a high degree of compatibility, there was no inflammatory reaction with this agent after 12weeks and was not associated with a significant foreign body reaction at any time during the study.

Scrotal Calcinosis: Analysis of 5 Cases

Idiopathic scrotal calcinosis (ISC) is an uncommon benign process, characterized by solitary or multiple, painless, strict scrotal nodules in the lack of systemic metabolic disorder. Its nature and reason have remained unknown and theories of origin contain idiopathic calcification arising within normal scrotal collagen, dystrophic calcification of inflamed scrotal epidermoid cysts, eccrine duct milia or dartoic muscle, and secondary to minor trauma. A total of 5 cases were found for ISC in our department of pathology. All patients underwent surgical excision of the lesions with overlying skin. Age range was from 25 to 49 years with a mean age of 31.4 years. Three of the patients with multiple lesions (3/5). The common appearance of the masses were hard, slowly growing, semi-mobile, lobulated, and well-circumscribed subcutaneous nodules. Diameter of the lesions ranged 0.7cm to 3cm. Grossly, there were firm, white with chalky and gritty areas. H&E stains revealed basophilic masses in dermis with foreign body giant cell reaction in 4 cases. No recurrences were noted. ISC is a rare, benign, disease of the scrotal skin that is characterized by calcium depositions of various sizes surrounded by a granulomatous reaction. In spite of the debate about the origin of this entity, surgery still seems to be the treatment of option and provides a good clinical outcome.

Epidermal inclusion cyst with foreign-body giant-cell reaction treated with surgical excision and rotational flap closure: A case report

Epidermal inclusion cysts (epidermoid cysts) occur from penetration of epidermal cells into underlying dermal tissue. They are most commonly found on the scalp, face, neck, and back with a reported incidence of 10% on the extremities. We present the case of a 53-year-old female who presented with complaint of a painful plantar forefoot soft-tissue mass of insidious origin. After magnetic resonance imaging, she was treated with surgical excision and plastic rotational flap closure. The surgical site healed without incident, and she was able to ambulate pain free in her normal footwear with full weight bearing and no shoe modifications or orthotics. This case was novel in that the size of the lesion required the use of a uni-lobe full-thickness rotational skin flap to achieve complete tension-free closure.

Histopathology of synovial cysts of the spine

Cystic lesions derived from the synovial and ligamentous structures of the spine have varied histological appearances. Not uncommonly, there is discrepancy between the clinicoradiological diagnosis and histology. Therefore, we sought to characterise the histological features of tissue submitted as 'synovial cysts' of the spine. Resected specimens of the spine labelled 'synovial cysts' and 'lumbar cysts' were histologically evaluated and classified on the basis of histopathological features. Seventy-five histological samples of spinal cysts were identified. Thirty-one were classified as synovial cysts (definite synovial lining), 28 showed pseudocystic degeneration of the ligamentum flavum, seven showed pseudocyst formation without evidence of a synovial lining or degeneration of the ligamentum flavum, and eight showed cyst contents only or no histological evidence of cyst wall for evaluation. Twenty-five cases (33%), especially those showing pseudocystic degeneration of the ligamentum flavum, were associated with very characteristic tumour calcinosis-like calcium deposition with a surrounding foreign-body giant-cell reaction. Histology of 'synovial cysts' of the spine shows varied types of cyst; a large proportion are not synovial-lined cysts, but rather show pseudocystic degenerative changes of the ligamentum flavum, often associated with very characteristic finely granular calcifications and a foreign-body giant-cell reaction. This may have implications not only for understanding the pathogenesis of these lesions, but also for their varied responses to non-surgical interventions.

Man with a swollen mass on sacrococcygeal region.

A 43-year-old male patient presented to the emergency department with 8 days of a painful swollen mass on sacrococcygeal region. He had no personal or family medical conditions and was receiving cephalexin 500 mg four times a day two days ago. Examination revealed an erythematous, fluctuant, swollen mass on sacrococcygeal region and an orifice at the buttock cleft (A). He was afebrile and nontoxic. Laboratory study results were unremarkable. Incision, drainage, currettage were made, leaving the surgical wound open for secondary healing. The diagnosis of pilonidal cyst with abscess was performed. Pilonidal sinus probably derives from the perineal pilosebaceous unit and precursor pits associated with trapped hairs. The penetrating hairs may cause a foreign-body giant cell reaction, sometimes with secondary bacterial infection, with can cause a sudden onset of pilonidal abscess. It occurs more commonly in individuals with stiff dark or auburn hair. There are four clinical presentation of the disease: symptomatic, acute pilonidal abscess, chronic fistulizing form or complex pilonidal sinus disease. Chronic fistulizant form is the most common clinical presentation. The sacrococcygeal location is the most common site but it can occur on the pubis, anterior perineum and very rarely, the penis. Asymptomatic pits do not require treatment. For acute abscesses, the options available are: aspiration followed by treatment with antibiotics and later curative intent surgery; drainage without curettage; drainage and curettage.

Pathological findings in explanted vaginal mesh

In light of the legal issues and the shortage of data on histopathological findings, we summarized our experience on how explanted vaginal mesh specimens were managed in a surgical pathology practice during the last 5 years. Clinical history and pathology reports were collected from 155 women undergoing transvaginal tape excision. The degree of chronic inflammation, fibrosis, foreign-body giant cell reactions, the number of capillary vessels and nerve fibers, and the presence or absence of adipose tissue were recorded. Among the 155 patients, 65 (41.9%) were active medicolegal cases, with a significant increase in recent years. The main medical indications for mesh excision were pelvic pain, mesh erosion, voiding dysfunction, genital organ prolapse, and vaginal bleeding. In most cases, mild to moderate chronic inflammation with a mild degree of foreign-body giant cell reaction and minimal to mild fibrosis were found in explanted mesh specimens. The specimens were well vascularized without any evidence of nerve abnormality. Patient age correlated negatively with vaginal pain (P = .007) but positively with erosion (P = .005). In addition, the presence of adipose tissue within the explanted mesh correlated significantly with pelvic pain (P = .016). Overall, there was good tissue integration in all specimens. Considering the significant increase in the number of lawsuits in recent years, we recommend that all explanted vaginal mesh specimens be examined microscopically as well as grossly. A list of microscopic findings, including the presence or absence of adipose tissue, is suggested.

Histological Analysis of Early Osteolysis in Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: The purpose of this study was to perform a histological comparative analysis of tibiotalar joint samples taken from areas of osteolysis adjacent to total ankle arthroplasties vs control synovial specimens to determine the reaction to and presence of polyethylene (PE) particles. Methods: A total of 57 pathology samples were identified in the osteolysis group, while 11 were identified in the control group. For each sample, hematoxylin and eosin, Oil Red O (ORO), and macrophage marker CD163-stained slides were created. Polarized light and ORO stain were used to identify PE particles. The presence of metal particles and giant cell reaction to PE particles were also scored. Results: Macrophages, PE particles, metallosis, and foreign body giant cell reaction scores were significantly higher in the osteolysis group compared with the control group. In the osteolysis group, ORO staining was positive in 93% (53/57), birefringent material was present in 96.5% (55/57), and macrophage infiltrates were present in 96.5% (55/57). Foreign body giant cell reaction with giant cells surrounding PE particles was present in 49.1% (28/57) of osteolytic specimens. The presence of foreign body giant cell reaction was associated with significantly higher macrophage, ORO, and polarizable material scores. The average time to surgery for osteolysis from the index ankle replacement was 6.0 (range, 0-15) years for the 57 patients in the osteolysis group. Conclusion: This study is the largest ankle arthroplasty histological analysis to show that areas of osteolysis consist of abundant polyethylene wear particles, present both intracellularly and extracellularly. Furthermore, these areas were associated with a CD163+ macrophage infiltrate and frequently a foreign body reaction with giant cells engulfing PE particles. It is likely that implant wear particles play a significant role in osteolysis based on the histopathology.

Development of a New Outcome Prediction Model in Early-stage Squamous Cell Carcinoma of the Oral Cavity Based on Histopathologic Parameters With Multivariate Analysis: The Aditi-Nuzhat Lymph-node Prediction Score (ANLPS) System.

The aim of this study was to evaluate the histopathologic parameters that predict lymph node metastasis in patients with oral squamous cell carcinoma (OSCC) and to design a new assessment score on the basis of these parameters that could ultimately allow for changes in treatment decisions or aid clinicians in deciding whether there is a need for close follow-up or to perform early lymph node dissection. Histopathologic parameters of 336 cases of OSCC with stage cT1/T2 N0M0 disease were analyzed. The location of the tumor and the type of surgery used for the management of the tumor were recorded for all patients. The parameters, including T stage, grading of tumor, tumor budding, tumor thickness, depth of invasion, shape of tumor nest, lymphoid response at tumor-host interface and pattern of invasion, eosinophilic reaction, foreign-body giant cell reaction, lymphovascular invasion, and perineural invasion, were examined. Ninety-two patients had metastasis in lymph nodes. On univariate and multivariate analysis, independent variables for predicting lymph node metastasis in descending order were depth of invasion (P=0.003), pattern of invasion (P=0.007), perineural invasion (P=0.014), grade (P=0.028), lymphovascular invasion (P=0.038), lymphoid response (P=0.037), and tumor budding (P=0.039). We designed a scoring system on the basis of these statistical results and tested it. Cases with scores ranging from 7 to 11, 12 to 16, and ≥17 points showed LN metastasis in 6.4%, 22.8%, and 77.1% of cases, respectively. The difference between these 3 groups in relation to nodal metastasis was very significant (P<0.0001). A patient at low risk for lymph node metastasis (score, 7 to 11) had a 5-year survival of 93%, moderate-risk patients (score, 12 to 16) had a 5-year survival of 67%, and high-risk patients (score, 17 to 21) had a 5-year survival of 39%. The risk of lymph node metastasis in OSCC is influenced by many histologic parameters that are not routinely analyzed in pathologic reports. These significant independent factors were graded to design a scoring system that permits accurate evaluation of the risk of metastasis with accuracy independent of the traditional TNM system or isolated histologic parameters. The need for neck node dissection can be predicted depending upon the scores obtained.

Hydrophilic Polymer-associated Ischemic Enterocolitis.

Hydrophilic polymer coating of medical devices serves to lubricate the device and prevent device-related complications. The coating can be mechanically disrupted and result in downstream injury via presumed thromboembolism. This process has been reported in the brain, heart, lung, and skin, and has been replicated through animal studies and in vitro histologic processing of the polymer coating. We report the first description of hydrophilic polymer-associated ischemic enterocolitis in a series of 7 specimens (small bowel=2, colon=4, aortic thrombus=1) from 3 patients. We report a 4% incidence among all patients with an ischemic bowel resection between April 29, 2014 and August 8, 2016. All patients developed bowel ischemia within 1 day of aortic repair, and all bowel resection specimens showed polymers, mainly in the submucosal vessels in areas of extensive ischemia. The polymers appeared as basophilic, intravascular, serpiginous structures. In a patient who developed acute paralysis after the aortic repair, identical polymers were identified in the aortic thrombus and the ischemic bowel segment. We demonstrate that the polymers display an altered morphology over time and with various graft types, and that the degrading polymers are associated with a foreign body giant cell reaction. Special stains can aid in diagnosis, with the polymers turquoise on a colloidal iron stain, pink on von Kossa and mucicarmine stains, and pale blue on trichrome. Clinical follow-up was available up to 115 weeks: 1 patient died, and 2 are alive and well. In summary, we report a new diagnostic entity to be considered in the differential diagnosis of iatrogenic ischemic injuries in the gastrointestinal tract. Awareness of this entity is important to elucidate the cause of ischemia and to prevent misdiagnosis of the polymers and their associated giant cell reaction as a parasitic infection, granulomatous vasculitis, sarcoidosis, and idiopathic inflammatory bowel disease.