Type Giant Cells Research Articles

Atypical Signs and Symptoms of Giant Cell Arteritis: A Systematic Review.

Giant cell arteritis can present with atypical manifestations that delay treatment and risk severe complications. To comprehensively describe all atypical signs/symptoms of giant cell arteritis. In this systematic review, we searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to October 2022. Primary research articles that included at least one participant with an atypical sign/symptom of biopsy-proven giant cell arteritis were included. Study screening and data extraction were performed in duplicate. The primary outcome was the proportion of participants with atypical giant cell arteritis features. Time to treatment was compared between participants with atypical giant features only and participants with both typical and atypical features. Of 21,828 screened records, 429 studies corresponding to 746 individuals (median [IQR] age 72 [IQR, 66-78] years, 63% female) with at least one atypical feature of GCA were included. Eighty-two percent had both atypical and at least one concurrent typical giant cell arteritis feature, whereas 18% of patients with atypical signs and symptoms only presented with atypical features. Patients with atypical symptoms presented to clinicians earlier than patients with typical features (p < 0.001). There was no difference between groups in proportion to elevated ESR and CRP (82.3% vs. 83.35%, p = 0.91) or mortality rate (8.2% vs. 10.8%, p = 0.42). Patients with atypical features only experienced greater delay in treatment initiation (p < 0.001). The most commonly reported atypical signs/symptoms were vertigo (11.9%), scalp necrosis/ulceration (7.9%), and dry cough (5.8%). Eighteen percent of biopsy-proven giant cell arteritis cases with at least one atypical feature have only atypical features and are more likely to experience delays in treatment. Clinicians should be aware of atypical signs/symptoms of giant cell arteritis and order inflammatory markers early to prevent giant cell arteritis-associated morbidity.

023. Isolated Calvarial Tuberculosis in An Immunocompromised Patient: A Case Report

Background: Isolated Calvarial tuberculosis is a rare occurrence, first reported by Reid in 1842, with majority of cases (75-90%) appearing under the age group of 20-30 years and involving frontal and parietal bones because of the greater amount of cancellous bone with diploic channels. The Human Immunodeficiency Virus (HIV) Infection is currently a huge threat to Indonesia, with Tuberculosis (TB) infection is one example of opportunistic infection that can lead to death in People living with HIV. The objective of this article is to report a rare case of Isolated Calvarial Tuberculosis in an Immunocompromised Patient Case: A 26-year-old male, known to be immunocompromised with HIV infection, presented to hospital with chief complaint of a painless lump on the left temple since 1 month prior. Head CT-Scan examination revealed osteolytic appearance in the left frontal area and swelling of the surrounding soft tissue. The patient then underwent surgery with intraoperative findings of a cystic mass filled with yellowish fluid. A craniotomy of the surrounding healthy bone including the dura mater and excision of the overlying soft tissue were performed, and histopathological result revealed a chronic tuberculosis inflammation. Conclusion: Calvarial Tuberculosis is a rare form of skeletal tuberculosis occurring in younger population, but can also present in older patient with immunocompromised state, that present with main complaint of painless swelling or lump in the frontal or parietal area because of its favourable bone structure. Diagnostic including X-ray and CT-Scan with microbiologic findings of multiple epithelioid granulomas with Langerhans type giant cells. Preferred treatment including both surgical and antituberculosis therapy to achieve favourable outcome.

Histomorphological features of pulmonary tuberculosis in Asian elephants (Elephas maximus)

Tuberculosis in Asian elephants usually shows involvement of lungs and associated lymph nodes. Grossly, the affected lobes of lungs reveal circumscribed lesions of varying sizes with central areas of caseation and necrosis. This report documents histomorphological features of pulmonary tuberculosis in six Asian elephants. The important cell types present were lymphocytes, foamy macrophages, epithelioid macrophages and Langhan’s type of giant cells. In addition, caseation necrosis, fibrotic capsule, and mineralisation (calcification) were also observed. Characteristic features of tuberculoid granulomas observed in the six cases showed similarities with other species. The six cases showed varying proportions of the seven defined features but all features were present together only in one case Keywords: Granuloma, histopathology

8031 Pelvic Fracture Related to Brown Tumor in Severe Secondary Hyperparathyroidism

Abstract Disclosure: M. Bodenstab: None. M. Lieberman-Ulm: None. V.S. Lagari-Libhaber: None. Background: Severe hyperparathyroidism can result in end-organ damage to the skeleton, known as osteitis fibrosa cystica (OFC). Histologically, OFC manifests as “Brown tumors”, which are so named due to the hemosiderin deposition that occurs from recurring microtraumas with subsequent hemorrhage. Typical sites of presentation include the mandible, clavicle, ribs, or pelvis, but can occur anywhere in the body. Patients can present with diffuse bone pain, pathological fracture, or bone deformities, though some may be asymptomatic and diagnosed incidentally. While these tumors do not have malignant potential, they can become debilitating in their burden and mimic malignant disease. Treatment focuses on treating the underlying cause of the hyperparathyroidism. Clinical Case: A 52-year-old female with ESRD on thrice weekly hemodialysis secondary to T2DM and HTN presented with right thigh pain and difficulty bearing weight, which began one week after a mechanical fall from standing. X-ray on admission revealed acute nondisplaced pathologic fracture of the right superior pubic ramus related to an underlying 4.7 x 2.2 cm expansile osteolytic lesion. Calcium level corrected for albumin on admission was 9.3 mg/dL, phosphorous 5.6 mg/dL, and PTH 563 pg/mL. Review of our institution’s electronic medical record revealed a maximum PTH level of 1,808 pg/mL three months prior. On CT pelvis, the patient was found to have multiple osteolytic lesions also involving the sacrum, multiple vertebral bodies, and the left pubic ramus, concerning for metastatic disease. Patient underwent pelvic rami bone biopsy resulting as osteoclast type giant cells, hemosiderin deposition and fibrosis in keeping with "brown tumor" of hyperparathyroidism. The patient was started on Cinacalcet 30 mg daily, with plans to titrate as outpatient to target PTH levels. She was also instructed to continue calcium, vitamin D and calcitriol to treat the underlying condition of metabolic bone disease from CKD. Referrals were given for both orthopedic spine and orthopedic oncology for surgical evaluation of her lesions. Discussion: Osteitis fibrosa cystica has become exceedingly rare in the United States and occurs in about 2% of patients with hyperparathyroidism. Due to their low prevalence and radiologic similarity to neoplasm, “Brown tumors” may be mistaken for metastatic disease and can lead to delay in diagnosis. Histology reveals collections of osteoclasts due to excess activity intermixed with fibrous tissue and poorly mineralized woven bone, which will differentiate brown tumor from malignancy. However, further correlation with hypercalcemia and hyperparathyroidism is imperative as brown tumors and other giant cell-containing lesions may be difficult to differentiate histologically. We present this case due to its rarity in clinical practice. Presentation: 6/2/2024

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.

Pituitary Tuberculosis - A Rare Case Report

Tuberculosis is an infectious disease primarily affecting lungs and also involves any body organ. Intracranial tuberculosis constitutes about 0.15-5% of all intracranial space-occupying lesions. Pituitary gland as primary site for tuberculosis is very rare. Delayed diagnosis and treatment can result in permanent endocrine dysfunction. Here we present a case in a 44-year-old female presented to the hospital with complaints of progressive worsening headache, left eye pain, and blurred vision for 6 months. Patient was evaluated and radiological workup was done. MRI brain with contrast showed enhancing mass lesion of 1.7x1.4 cm arising from Sella with mass effect on optic chiasma and it was radiologically diagnosed as pituitary adenoma. A biopsy from the pituitary region was obtained and histopathological examination was done. Microscopic examination revealed pituitary gland parenchyma showing well-formed epithelioid granulomas consisting of epithelioid cells, Langhans type of giant cells, and chronic inflammatory cells along with foci of caseous necrosis. The case was finally diagnosed as pituitary tuberculoma. Keywords: Tuberculosis, granuloma, space-occupying lesion, pituitary gland.

An Anaplastic Thyroid Carcinoma of the Giant-Cell Type from a Mediastinal Ectopic Thyroid Gland.

Anaplastic thyroid carcinoma is a rare, aggressive form of thyroid carcinoma with a mean survival of less than 6 months. Ectopic thyroid tissue can be present in the mediastinum due to faulty embryogenesis with improper descent. Primary thyroid malignancies may arise from this ectopic tissue. A 90-year-old male with a history of prostatic adenocarcinoma, hypothyroidism, and occupational and therapeutic exposure to radiation presented with a rash on his chest. A review of the dermatopathology and excised mediastinal specimen revealed rare papillary foci that tested positive for thyroid markers from a background of poorly differentiated components. Molecular analysis confirmed a BRAF V600E mutation in the specimen. The final diagnosis was anaplastic thyroid carcinoma of the giant-cell type. Given the atrophic cervical thyroid tissue in the patient's neck with no evidence of previous surgery, this carcinoma was believed to arise from ectopic mediastinal tissue associated with cutaneous and bony metastasis. In conclusion, anaplastic thyroid carcinoma is an aggressive and rare thyroid malignancy that can arise from ectopic thyroid tissue in the mediastinum and should be considered in the differential diagnosis of primary undifferentiated mediastinal malignancies with bony involvement.

Tuberculosis of the scalp in a 13-year-old child: A common entity at an uncommon location – A rare case report

ABSTRACT Tuberculosis (TB) caused by Mycobacterium tuberculosis manifests as pulmonary and extrapulmonary forms with cutaneous TB being rare and TB of scalp even rarer. We report the case of a 13-year-old girl who was admitted with a 4-week history of painful swelling and ulcer on the scalp and occasional cough. She had a history of falling on the head 6 months ago. On physical examination, the ulcer measured 6 cm in diameter and was tender with a yellowish-white crust. Contrast-enhanced computed tomography of the head showed a well-defined hypodense peripherally enhancing lesion overlying the left parietal bone with the destruction of the underlying bone. A clinical diagnosis of frontal bone osteomyelitis was made. Abscess drainage was done with excision of the lesion which on histopathological examination showed abundant necrosis with few ill defined epithelioid cell granulomas, langhans type of giant cells, and chronic inflammatory infiltrates. Ziehl–Neelsen staining for acid-fast bacilli was negative, whereas molecular testing by GeneXpert Rifampicin Assay was positive for M. tuberculosis. Thus, a diagnosis of tubercular osteomyelitis was made. Our patient was prescribed four drugs antitubercular regimen for 1 year. On follow-up after 6 months, she is doing fine without any signs and symptoms of the disease. TB should always be kept in mind as the differential diagnosis keeping its varied presentation and high prevalence in our country.

Identification of a Unique Morphological Pattern for the Diagnosis of Fungal Rhinosinusitis.

Fungal rhinosinusitis (FRS) is a relatively common, but often misdiagnosed disease of paranasal sinuses. The FRS is classified into invasive and non-invasive forms. The non-invasive form includes fungal ball and allergic FRS, and invasive form includes acute invasive FRS, chronic invasive FRS, and granulomatous FRS. Invasive fungal infections are associated with high morbidity and mortality, hence requiring urgent medical and surgical intervention. The histomorphology can help identify certain fungal organisms that cannot be cultured or are rarely visible in exudates. The morphologic diagnosis of tissue invasive and non-invasive fungal infection is essential for appropriate treatment. We analyzed cases of rhinosinusitis from 2017 to 2019 in Pathology Department at a tertiary care cancer hospital, Lahore, Pakistan. All clinical information was retrieved from patient records. Paraffin-embedded tissue blocks were stained with hematoxylin and eosin (H&E), special Grocott methenamine silver stain (GMS), and periodic acid Schiff stain (PAS) according to standard protocol. They were reviewed by two pathologists blinded by fungus status. A total of 169 cases of rhinosinusitis were reviewed. FRS comprised 146 (86.4%) of them. The mean age of patients with FRS was 32.8±14 years. The male:female ratio was 1.4:1. Maxillary sinus was the main site of involvement in 39 (27%) FRS cases. Aspergillus was identified in 117 (80.1%) cases of FRS. The culture reports were available in 44/146 (30.14%) FRS cases. They were negative in 22/44 (50.0%), and Aspergillus species were isolated in 18/44 (40.9%) cases of FRS. There were 84 (57.5%) cases of non-invasive FRS and 59 (40.4%) cases of invasive FRS. Among invasive FRS, there were 56 (38.4%) chronic granulomatous FRS cases including mixed patterns. Majority cases, 54 (96.4%), of chronic granulomatous FRS showed a unique crowded giant cell pattern comprising of foreign body and Langhans type giant cells. These giant cells were arranged closely forming irregular non-caseating granulomas surrounded by lymphocytes and fibrosis. Interestingly, the giant cells were scattered haphazardly without forming a granuloma as well. Fungal organisms were identified in all 56 cases of chronic granulomatous FRS. Histologically, predominant organism was Aspergillus in 48 (85.7%) on GMS and PAS stain. Our study observed a unique crowded giant cell pattern, which is a hallmark of invasive fungal infection. If pathologists are familiar with this unique pattern, they can make a quick and accurate diagnosis on histology. The physician can start antifungal treatment timely for better prognosis.

Erythema Induratum of Bazin: A Rare Finding in an Old Woman with Subcutaneous Nodules in the Lower Limbs

Erythema induratum of Bazin (EIB) is a chronic nodular eruption that frequently occurs on lower legs of young or middle-aged women. The clinical manifestations of EIB revealed various dermatological disorders that can be easily leads to misdiagnosis. We report a case of a 50-year-old woman who initially presented with EIB. The histopathological specimen was collected from her medial aspect of let leg. The epidermis is unremarkable. The dermis shows fibro fatty tissue, skin adnexae and foci of granuloma with Langhans type of giant cells and some lymphocytic infiltration in the deep dermis which was suggestive of erythema induratum. Her lesions responded to antitubercular therapy (ATT). This case study may help extend the therapeutic regimens for cutaneous tuberculosis.&#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 121-123

Management of wet ascitic type of peritoneal tuberculosis: single center experience.

We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic confirmation of wet ascitic type of peritoneal tuberculosis (TB). Between January 2008 and March 2019, 17 patients whose ascites were investigated by a gastroenterologist and who were thought to have non-cirrhotic ascites were referred to our Surgery clinic for peritoneal biopsy. The clinical, biochemical, radiological, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed retrospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eosin-stained preparations revealed necrotizing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Ehrlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopathological findings were also considered. Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdominal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologically, necrotizing granulomatous peritonitis consistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen patients, laparotomy was preferred in the remaining one due to previous surgical procedures. However, seven were converted to open laparotomy. Diagnosis of abdominal TB requires high index of suspicion, and the treatment should be prompt to reduce the morbidity and mortality associated with delay in treatment.

Atypical fibroxanthoma with osteoclast type giant cells – a case report

Introduction: Atypical fibroxanthoma (AFX) are rare low-grade malignant cutaneous tumours. These tumours are dermally based, circumscribed, tend to be ulcerated, and are typically solitary. AFXs tend to occur in solar damaged skin on elderly individuals. The cytology of these tumours can be alarming, with neoplastic cells showing moderate to severe pleomorphism, epithelioid to spindled forms, and often atypical mitotic figures. A range of histologic variants have been described in the literature, including clear cell, myxoid, pigmented, and plaque like.

Labium superius oris mucormycosis: an enigma

Mucormycosis is an aggressive opportunistic fungal infection affecting immunocompromised patients. It has six manifestations: rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated and localized infection. However, isolated mucormycosis of upper lip (labium superius oris) without any bony invasion has not been reported in literature to the best of our knowledge. Hence this poses a diagnostic challenge. A 50-year-old male came with left sided nasal pain and left sided nasal obstruction associated with very mild uniform swelling of upper lip of 24 months duration. He underwent FESS in a local hospital and was misdiagnosed as granulomatous origin probably Tuberculosis. Even on ATT the symptoms didn’t subside and hence presented to our hospital. On incisional biopsy deep fungal infection probably mucor was reported and he was put on tab Posaconazole 300 mg OD. On recurrent upper lip swelling, excision biopsy was done. HPE was reported as fibrocollagenous stroma interspersed by multiple non-caseating epitheloid granulomas with plenty of foreign body type of giant cells. PAS showed broad aseptate acute angled hyphal forms suggestive of mucor. The follow up clinical presentation of the patient was very satisfactory with complete regression of upper lip swelling and no damage to surrounding structures. The case report highlights the existence of localized form of mucormycosis without bony necrosis in immunocompetent patients which require minimal surgical intervention along with oral medical therapy rather than extensive debridement.

Tuberculoid granuloma in bone marrow biopsy can be a rare cause of pancytopenia

Tuberculoid granuloma in bone marrow biopsy can be a rare cause of pancytopenia

Role of Denosumab in the Management of Giant Cell Tumor, a Cross Sectional Study

ABSTRACT Background: Giant cell tumor (GCT) of bone is a benign lesion which is characterized by presence of multinucleated osteoclasts type giant cells. Nuclear factor kappa B (RANKL) serves as the trigger factor for osteoclasts cells formation. Although surgery is the primary treatment for GCT of bone but recurrence remains the concern. Therefore, the development of denosumab, a monoclonal antibody for treating GCT for both primary and recurrent disease cases. The present study aims to show the role of denosumab along with surgery when given as neo-adjuvant drug to patients of GCT for their treatment. Methodology: A total of 23 patients diagnosed with GCT were included in this study from January 2016–December 2019 and all of these patients had received neo adjuvant denosumab dose of 120 mg SC on day 0, 15, 30 &amp; 45. All patients were treated at the section of Orthopedics, department of surgery, Aga Khan University hospital, Karachi. Other benign lesions were excluded from the study. Results: Out of 23 patients we had 12 (52.2%) males and 11 (47.8%) females. The mean age of our patients was 34±13.8 years and mean follow up duration of all patients was 20.5 ± 10.7 months. There were 15 (65.2%) primary cases of GCT while 8 (34.8%) were recurrent cases. In 8 (34.8%) of the cases primary site of lesion was distal femur followed by 7(30.4%) proximal tibia cases and 3(13%) distal radius cases. In surgical procedure 20 (87%) patients underwent wide margin excision and only 3 (13%) had intralesional curettage. Reconstruction was performed in 21 patients which consist of bone grafting in 9 patients and mega prosthesis insertion in 12 patients. Only two patients had no reconstruction. On final histopathology, there was no residual GCT and we observed no denosumab induced adverse effects. Post-operative complications included wound infection and peri prosthetic infection in 3 patients. On follow-up we had 4(17.4%) cases of recurrence that were offered revision surgery while 19 (82.6%) were disease free. Conclusion: Denosumab has shown successful results in treating patients with GCT along with surgical intervention and it can be a best option for treating recurrent disease as well. Highlights Research registration no: researchregistry4695

Characteristics of Patients with Giant Cell Tumor of Bone and High Serum Tartrate-Resistant Acid Phosphatase 5b Levels: Comparison of Tumor Volume and Clinical Factors.

Serum tartrate-resistant acid phosphatase 5b is well known to be increased in giant cell tumors of bone. However, there are only a few studies that analyzed the association with tartrate-resistant acid phosphatase 5b expression in those patients. Therefore, we analyzed the characteristics of patients with giant cell tumors of bone and high tartrate-resistant acid phosphatase 5b expression. This retrospective study included 26 patients with giant cell tumors of bone. The correlation between tartrate-resistant acid phosphatase 5b before initial treatment and tumor volume was evaluated. Patients were divided into two groups according to tartrate-resistant acid phosphatase 5b level. Statistical analysis was performed between the two groups. Tartrate-resistant acid phosphatase 5b was elevated in 17/26 patients, and the mean value was 852 mU/dL. There was no correlation with tumor volume (r = 0.034, P = 0.86). The mean age of 34.5 years in the HT group was significantly younger than the mean age of 47.4 years in the LT group (P = 0.040). Pathologically, 19/26 cases showed at least one focal area with features of typical giant cell tumor of bone. Although 11/18 patients in the LT group exhibited relatively noticeable secondary changes, all patients in the HT group exhibited typical features (P = 0.0074). Tartrate-resistant acid phosphatase 5b levels were not elevated in some giant cell tumors of bone. This study suggested that tartrate-resistant acid phosphatase 5b may be elevated in younger patients and in cases with fewer pathological secondary changes, regardless of tumor volume.

Fine Needle Aspiration Cytology in Effective Management of Patients with Granulomatous Inflammation in Neoplastic and NonNeoplastic Lesions

Background and Aim: Fine Needle Aspiration Cytology (FNAC) plays an important role in the diagnosis of tuberculous inflammation and prevents unnecessary surgery. Cytodiagnosis of tuberculosis depends on the demonstration of epithelioid cell granuloma and caseous necrosis with or without Langhans type of giant cells. Present study was done to assess the usefulness of the cytological study in the diagnosis of granulomatous lesions.Material and Methods: The present study was carried at the department of Pathology at tertiary care hospital over 12 months. Patients fulfilling inclusion criteria will be selected from fine needle aspiration cytology specimens after written consent. A routine stain like Hematoxylin and eosin (H&amp;E), Papanicolaou (PAP) and Giemsa stain will be done. Two extra unstained slides will be smeared from aspiration material.Results: Total 200 patients with granulomatous inflammation diagnosed on FNAC were taken. Among 200 cases, single swelling was present in 160 cases and multiple swellings were present in 40 cases. Out of which cervical was the commonest site. On FNAC, the nature of aspirate was blood mixed in 123 cases followed by aspiration of pus and cheesy material in 52 and 25 cases respectively. In the present study of 200 cases of granulomatous inflammation on FNAC, tuberculosis was the most common finding in 140 cases (70%). There was an association between AFB positivity and caseation necrosis.Conclusion: FNAC is still a good diagnostic tool in the evaluation of granulomatous lesions. Patients who are not responding to empirical AKT should be considered for other causes of granulomatous inflammation other than TB, and proper workup should be done.

Primary Tuberculosis of the Eye Lid – A Rare Manifestation, Case Report in a Tertiary Care Medical College &amp; Hospital

We present a case of cystic lobulated swelling on upper and lower lid margin in a 45 years old woman. No other local or systemic features were associated with it. An incisional biopsy was performed under local anaesthesia. The histopathological examination revealed epithelioid cell granulomas and multiple Langhans type giant cells (Tubercular).

Gastric Spindle Cell Neoplasms With Mast Cells - A Pitfall In Diagnosis Of Gastric Biopsies.

Abstract Introduction/Objective Undifferentiated sarcoma, previously known as malignant fibrous histiocytoma (MFH), is a very rare primary neoplasm of stomach. It usually arises from soft tissue of extremities with an incidence of 1- 2/100,000, typically presenting in the 5th-7th decades of life with a slight male predominance. We report a case of gastric undifferentiated sarcoma which was interpreted as gastrointestinal stromal tumor (GIST) on initial biopsy. Methods/Case Report A 84 year old female presented to the Danbury Hospital emergency department with hematemesis and melena. Upper gastrointestinal endoscopy revealed a pedunculated mass in the cardia of stomach with ulceration, followed by a computed tomographic scan of chest and abdomen revealing a 2.9 cm mass along the proximal lesser curvature of the stomach. An endoscopic biopsy revealed a spindle cell neoplasm with immunohistochemical staining for c-kit consistent with GIST. She later underwent partial gastrectomy. Histopathology of the resected gastric tumor showed tumor cells arranged in sheets and storiform pattern, exhibiting spindled to polygonal morphology with marked nuclear pleomorphism, high mitotic activity (20 mitoses per 10 high power fields) and Touton type giant cells. Immunohistochemical stains demonstrated absence of staining for c-kit, DOG-1, CD34, actin, desmin, S100, cytokeratin AE1/AE3, CD3, CD5, CD20, CD21, CD15, CD30, ALK1, myeloperoxidase, CD1a and LCA. Numerous mast cells within the tumor stained for c-kit. Molecular testing for c-kit and PDGFRA mutations were negative. A final diagnosis of undifferentiated sarcoma with features of myxofibrosarcoma was rendered. Results (if a Case Study enter NA) NA. Conclusion Undifferentiated sarcomas are high grade malignant mesenchymal neoplasms without clear cellular differentiation or immunohistochemical marker. Only 4% of the total cases of undifferentiated sarcoma have been reported to be arising primarily from the gastrointestinal tract. They carry a poor prognosis with a 5 year survival of 47%. The main pitfall in our case was the positive uptake of c-kit stain by mast cells which led to the diagnosis of GIST in first gastric biopsy. We want to stress the importance of entertaining this diagnosis in the differential when encountered with a malignant gastric spindle cell neoplasm along with careful interpretation of c-kit stains in small biopsy specimens as the treatment and prognosis differs greatly from GIST.

In Vitro and In Vivo Cell-Interactions with Electrospun Poly (Lactic-Co-Glycolic Acid) (PLGA): Morphological and Immune Response Analysis.

Random electrospun three-dimensional fiber membranes mimic the extracellular matrix and the interfibrillar spaces promotes the flow of nutrients for cells. Electrospun PLGA membranes were analyzed in vitro and in vivo after being sterilized with gamma radiation and bioactivated with fibronectin or collagen. Madin-Darby Canine Kidney (MDCK) epithelial cells and primary fibroblast-like cells from hamster’s cheek paunch proliferated over time on these membranes, evidencing their good biocompatibility. Cell-free irradiated PLGA membranes implanted on the back of hamsters resulted in a chronic granulomatous inflammatory response, observed after 7, 15, 30 and 90 days. Morphological analysis of implanted PLGA using light microscopy revealed epithelioid cells, Langhans type of multinucleate giant cells (LCs) and multinucleated giant cells (MNGCs) with internalized biomaterial. Lymphocytes increased along time due to undegraded polymer fragments, inducing the accumulation of cells of the phagocytic lineage, and decreased after 90 days post implantation. Myeloperoxidase+ cells increased after 15 days and decreased after 90 days. LCs, MNGCs and capillaries decreased after 90 days. Analysis of implanted PLGA after 7, 15, 30 and 90 days using transmission electron microscope (TEM) showed cells exhibiting internalized PLGA fragments and filopodia surrounding PLGA fragments. Over time, TEM analysis showed less PLGA fragments surrounded by cells without fibrous tissue formation. Accordingly, MNGC constituted a granulomatous reaction around the polymer, which resolves with time, probably preventing a fibrous capsule formation. Finally, this study confirms the biocompatibility of electrospun PLGA membranes and their potential to accelerate the healing process of oral ulcerations in hamsters’ model in association with autologous cells.