Gigantocellular Granulomas Research Articles

Poncet rheumatism secondary to ceco-appendicular tuberculosis in systemic lupus erythematosus

Background. Poncet’s rheumatism (RP) is an aseptic reactive arthritis secondary to active tuberculosis. Systemic lupus erythematosus (SLE) and tuberculosis are intricately related with an increase in the risk of tuberculosis in SLE. We present an original case of Poncet’s disease secondary to appendicular tuberculosis in patient with lupus disease. Case report. A 36-year-old female was followed in internal medicine for systemic lupus. In September 2023, she suffered from digestive complaints and polyarthritis. Infectious investigation and microbiologic study of joint fluid was negative. She had tenderness on pressure on the right iliac fossa. The computed tomography (CT) found an appendicular mucocele. She underwent laparotomy with right colectomy. Macroscopic aspect revealed tumorous lesion suggestive for malignancy. Histological study concluded to granulomatous inflammation with epithelioid and gigantocellular granulomas with anhist necrosis. Ceco-appendicular tuberculosis was retained. The patient received the anti-tuberculosis therapy with good progress. Conclusions. Early recognition of atypical location of tuberculosis leads to initiate appropriate treatment especially in immune compromise statue patient.

A Rare Case of Retroperitoneal Sarcoidosis

Sarcoidosis is a systemic granulomatosis of undetermined etiology characterised by the formation of epithelioid and gigantocellular granulomas without caseous necrosis in the affected organs. Our case has a history of sarcoidosis with left flank pain. CT scan founded a left hydronephrosis secondary to a retroperitoneal mass encasing the lumbar ureter which was shunted by a double j stent. Biopsy of the mass showed fibrous tissue with epithelioid and gigantocellular granuloma without caseous necrosis. Our patient is an extremely rare case report.

Clinical-pathological characteristics and management of fusocellular tumors. Our experience

Introduction: Fucocellular tumors encompass a spectrum of very rare entities. Prognostic factors for the risk of relapse and overall survival such as tumor size, surgical margin, histological strain, and stromal growth are described. Materials and methods: Observational, analytical and cross-sectional study, which studied patients with a diagnosis of fusocellular tumor, treated in the Breast Pathology Service of the Marie Curie Municipal Oncology Hospital (HOMC) of Buenos Aires during the period 2003 to 2022. Quantitative variables were used and analyzed with measures of central tendency. For the comparison of these variables, the Chi 2/Fisher exact test was used. Results: A total of 58 patients with diagnosis of spindle-cell lesions were recruited, including Filode tumors, sarcomas, hamartomas, adenomyoepithelioma, aggressive fibromatosis, gigantocellular granuloma, fusocellular lesion. Conclusion: It was observed that early age (<40 years) is not a risk factor for relapse, with an increase in this index in patients with tumor size > 5 cm. The percentage of relapses was not modified when conservative surgeries vs mastectomies were compared.

A Rare Presentation of Muscle Involvement in Sarcoidosis: A Case Report

<i>Background</i>: Sarcoidosis can affect virtually any organ of the body, primarily the lungs, lymphatic system, skin or eyes, or a combination of these sites and it is characterized by the formation of non-caseating granulomas. Muscular involvement in sarcoidosis is usually asymptomatic or pauci-symptomatic, and its nodular form is exceptional. <i>Observation</i>: In this study, we report the case of a 36-year-old man who had been presenting with nodules in both calves for about two years which onset was progressive. These nodules were painless and deeply embedded in the gastrocnemius muscles. There were no functional complaints, and the general condition was preserved. The physical examination, especially at skin level was free of other clinical signs except the nodules. The PET-scan (positron emission tomography) revealed a few discretely hypermetabolic cervico-axillary lymph nodes and multiple bilateral mediastino-hilar adenopathies involving all lymph nodes, as well as multiple bilateral hypermetabolic pulmonary foci. Biopsy of accessory salivary glands (BASG) exhibited an epithelioid and gigantocellular granuloma without necrosis that confirm the diagnosis of systemic sarcoidosis. The search for another location, notably cardiac, ophthalmological, neurological, or renal, was negative. The respiratory function tests did not show any restrictive syndrome or abnormalities in the DLCO/VA ratio. It was therefore a systemic sarcoidosis with mediastino-pulmonary stage II, diffuse lymph node, splenic, and muscle involvement. <i>Conclusion</i>: This case shows the importance of BASG in the diagnosis of muscular sarcoidosis, in case of impossibility of performing a muscle biopsy.

Pseudo-tumor renal tuberculosis: a case report

BackgroundRenal lesion is a very frequent location of tuberculosis disease, the diagnosis of which is often difficult and delayed due to its atypical clinical presentations, especially in its pseudo-tumoral form.Case presentationPatient of 54 year old was referred after a kidney mass was found on an abdominal ultrasound. In addition, the patient reported the notion of minimal intermittent low back pain with weight loss. On computed tomography, it was a nodular lesion of the superior pole of the right kidney, and it has a heterogeneous density and a suspicious appearance. A total nephrectomy was performed by subcostal incision. Pathological examination of the specimen revealed the presence of diffuse gigantocellular granulomas with caseous necrosis suggestive of renal tuberculosis.ConclusionDespite the rarity of this form, renal tuberculosis should always be thought in order to avoid radical treatment.

Primary Prostatic Tuberculosis: A Rare Entity

Objectives: To clarify the clinical, histological and therapeutic features of prostatic tuberculosis. Methods: We conducted a single-centre retrospective descriptive study of all patients presenting with prostatic tuberculosis between January 2002 and December 2020. Patients who were lost to follow-up, could not be reached by telephone or whose records were not usable were excluded from this study. Results: 240 patients were treated for urogenital tuberculosis, including 13 for isolated prostatic tuberculosis. The average age of the patients was 75 years. None of our patients had a history of tuberculosis. The average of international prostate symptom score (IPSS) was 27. Lower urinary tract symptoms in the filling phase were predominant. The digital rectal examination was suspicious in only one patient. The mean preoperative PSA was 9.24 ng/ml. 46.15% of patients underwent transurethral resection of the prostate and 53.85% underwent ultrasound-guided prostate biopsy. Histological examination showed epithelioid gigantocellular granuloma with isolated caseous necrosis in 61.53% of patients and associated adenomyomatous hyperplasia in 38.47% of patients. Antituberculosis treatment was given for 6 months. The average of follow up was 15 months. All patients reported an improvement in clinical signs with a mean post operative IPSS score of 17 and a normalisation of PSA levels. Conclusion: Isolated prostatic tuberculosis is a rare entity, it can simulate a cancer. In front of the symptoms of the lower urinary tract, the clinicians must think of it especially in the developing countries where tuberculosis still prevails in an endemic state.

P507 Vulvar Crohn’s disease: A challenging diagnosis

Abstract Background Crohn’s disease is an inflammatory bowel disorder with several well-known extraintestinal manifestations, such as erythema nodosum, uveitis, and arthritis. Less commonly observed are cutaneous, so-called metastatic lesions of the vulva, which represent a diagnostic and therapeutic dilemma and require a multidisciplinary approach. The objective of this study was to report a case series of patients with vulvar Crohn’s disease (VCD), describe its clinical features, histopathologic characteristics and therapeutic management. Methods In this retrospective study, we reviewed all cases of VCD seen in our department between 2008 and 2016. Data concerning age at diagnosis of VCD, vulval symptoms at presentation, histologic findings, and different treatment modalities were recorded. Only patients with both clinical features of VCD [knife-cut fissures, edema, ulceration] and histologic confirmation were included. A total of 3 cases were identified among 106 female patients with CD. Results Case 1: A 58-year-old patient, presented with a 4-year history of vulvar pain and itching. She had no bowel complaints. Clinical examination revealed hypertrophic exophytic lesions associated with linear ulcearations involving the vulva. A biopsy from the lesional skin showed non caseating gigantocellular granuloma. In view of the clinical and histopathological features, a diagnosis of Crohn’s disease of the vulva was made. Anti TNF treatment with adalimumab was started, resulting in a significant regression of the lesions. Case 2: A 47-year-old patient presented to our department with complaints of painful, persisting vulvar ulcers, and resulting dysperunia for 2 years. On clinical examination she had unilateral vulvar oedema with multiple “knife-cut” linear ulcers. A skin biopsy was done which revealed dense inflammatory lymphocytic infiltrate with non caseating granulomas. Treatment with adalimumab was initiated. An improvement of symptoms was noted. Case 3: A 16-year-old patient with no remarkable medical history, presented with a 2-year- history of persistent cheilitis and vulvar pain. Clinical examination of the external genitalia revealed ‘knife-cut’ vulvar fissures with important bilateral labial swelling and multiple papules on the surrounding skin. Histological analysis showed chronic inflammatory infiltrate with noncaseating tuberculoid granulomas. Anti-TNF treatment with infliximab was started with partial regression of lesions. Conclusion Our findings highlight the importance of keeping VCD on the differential diagnosis when faced with a range of vulvar symptoms. Anti-TNF agents seem to be an efficient treatment strategy for this particular localization.

Cutaneous tuberculosis with an unusual appearance and location.

Tuberculosis is a bacterial disease caused by mycobacterium tuberculosis. It's cutaneous form accounts for 2% of all extrapulmonary tuberculosis. We report a case of 30-year-old woman with nodules evolving for two years. Examination showed gums of genital and inguinocrural location, and scrofulous scars. Several diagnoses were discussed including tuberculosis, syphilis, actinomycosis, or cutaneous lymphoma. Skin biopsy revealed an epithelial giganto-cellular granuloma with caseating necrosis; the culture of a cutaneous fragment was positive for Mycobacterium Tuberculosis. Our case is original and unusual due to the uncommon clinical appearance and location of the nodules grouped in the inguinocrural region. The multiplicity of the clinical forms of cutaneous tuberculosis sometimes makes the diagnosis difficult. Gums and scrofulodermas remain the most frequent forms of cutaneous tuberculosis in Morocco. According to the immuno-anatomo-clinical classification, tuberculous gum is part of the multi-bacillary forms and is seen mostly in immunocompromised patients.

Anatomo-Clinical Case: Coexistence of Tuberculosis with Axillary Lymph Node Metastasis in Breast Carcinoma

Introduction: The coexistence of tuberculosis with axillary lymph node metastasis in breast carcinoma is uncommon. Observation: We report a case of a patient aged 59 years presenting a painless nodule in the right breast for one year. The scan and mammography revealed a long-axis node of 3 × 2 × 1 cm in the upper outer quadrant of the right breast ranked stage IV by the American College of Radiology (ACR), associated with a set of axillary lymph nodes and the largest one measuring 15 × 15 × 20 millimeters (mm). The breast biopsy helped diagnose a Scarff Bloom Richardson (SBR) grade II non-specific invasive carcinoma, modified by Ellis and Elston. A right mastectomy associated with a lymph node dissection was performed. We noticed a not well defined and whitish 5 mm tumor mass associated with 16 lymph nodes removed. The histological examination confirmed the diagnosis of SBR grade II non-specific invasive carcinoma with invasion of 7 lymph nodes (N+ = 7/16). In 3 metastatic lymph nodes, there were epithelioid and gigantocellular granulomas with full central necrosis. The Ziehl Neelsen staining had highlighted acid-fast bacilli. The tumor was oestrogen and progesteron receptor, without an overexpression of the oncoprotein human epidermal growth factor receptor 2 (HER2), which corresponds to a 0 score and the Ki 67 proliferation index assessed at 10%. The patient was given an anti-tuberculosis treatment combining Rifampicin (H), Isoniazid (I), Pyrazinamid (Z), Ethambutol (E) over 2 months and secondly a combination of Rifampicin and Isoniazid over 4 months (2RHZE/4 RH). The anti-tumor chemotherapy used a protocol combining 3 FAC60+ 3 Docetaxel (F = Fluorouracil®; A = Adriblastin®, C = Cyclophosphamid). Conclusion: This coexistence is uncommon, of incidental discovery and necessitates a multidisciplinary care.

A rare aspect of Crohn's disease: Pulmonary involvement in a child.

Sir, I read with interest the case report by Ongun et al. on the pulmonary involvement in a Turkish child with Crohn's disease (CD).[1] The authors mentioned that “the patient's history of bronchiolitis episodes in the past suspecting of a subclinical pulmonary involvement, the aggravation of respiratory symptoms after colonic surgery which is accepted as a triggering factor, a sudden decline in C-reactive protein, and dramatic clinical improvement after the initiation of prednisolone appointed us the higher possibility of CD-related pulmonary involvement.”[1] The authors did well in studying deep tracheal aspirates that were evaluated for Mycobacterium tuberculosis species and viral respiratory organisms to rule out infliximab-related infections (all were negative).[1] However, they could not differentiate the cause of the inflammatory pulmonary disease by histopathological examination due to the parental disapproval for bronchoscopy.[1] Importantly, the authors did not consider another granulomatous pulmonary lesion in pediatric population that has received ample attention worldwide. I presume that pulmonary sarcoidosis ought to be scrutinized in the case in question by the suitable diagnostic workup. My assumption is based on the following four points. First, it is obvious that sarcoidosis, a chronic multisystem inflammatory granulomatous disorder of unknown origin, is a rare disease in children and pulmonary involvement is even much rare. Due to the nonspecific clinical features and the lack of a specific test, recognizing sarcoidosis can be difficult in the pediatric population.[2] Despite that, pediatric pulmonary sarcoidosis is increasingly reported in the literature.[3] In Turkey, the available data pointed out that children with sarcoidosis were noticed to have more frequent pulmonary parenchymal involvement than in adults.[4] Second, sarcoidosis and concomitant gastrointestinal CD have been reported in patients, as well as the coexistence of CD and sarcoidosis in siblings. Common susceptibility loci have been identified in CD and sarcoidosis.[5] Third, the studied patient's clinical condition and pulmonary functions improved dramatically after initiation of steroid therapy. This further supports the need to consider concomitant sarcoidosis as steroid represents the main-stay in the treatment of CD and sarcoidosis. Fourth, due to the lack of a specific test to precisely diagnose sarcoidosis, a biopsy specimen remains the gold standard with typical epithelioid gigantocellular granuloma without caseating necrosis granuloma, after other disorders known to cause granulomatous disease have been reasonably excluded, particularly tuberculosis.[2] In sarcoidosis patients, the angiotensin-converting enzyme (ACE) level in body fluids will become elevated.[2,5] Measuring ACE in bronchoalveolar lavage fluid can better sign the activity of the pulmonary sarcoidosis than in serum. I presume that the parental decline to do bronchoscopy in the case in question should lead the authors to consider measuring ACE level in deep tracheal aspirates as a last resort to exclude sarcoidosis. If that was achieved and it was proved to be a case of sarcoidosis, the case in question would be considered a novel case report of concomitant pediatric CD and sarcoidosis-associated pulmonary involvement as such association has never been described in the pediatric literature so far. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest

THU0292 Ct- Guided Disco–Vertebral Biopsy in the Diagnosis of Infectious Spondylodiscitis

BackgroundInfectious spondylodiscitis is a common cause of febrile back pain. CT- guided disco-vertebral biopsy (DVB) can provide the diagnosis of infectious spondylodiscitis and facilitate the identification of the causative micro-organism....

Granulomatous Reaction Within the Thyroid Metastases of a Renal Cell Carcinoma

Metastases of non-thyroid malignancies to the thyroid gland have been reported in 1.4% to 3% of patients undergoing thyroid surgery for thyroid malignancy. We report a case of thyroid metastases from renal cell carcinoma in a 57-year-old man, who underwent a left nephrectomy 11 years earlier for a renal cell carcinoma. The histological examination demonstrated a CD-10 positive and thyroglobulin and thyroid transcription factor-1 negative tissue, with numerous noncaseating gigantocellular granulomas. These findings are interesting for the possible role of the immune response in metastatic localizations.

Sarcoïdose à début précoce, difficultés diagnostiques en pédiatrie

Sarcoidosis, a chronic multisystem inflammatory granulomatous disorder of unknown origin, is a rare disease in children. Two distinct clinical presentations of sarcoidosis in childhood are known. Older children usually show multisystem disease, close to the adult manifestation, with lung infiltration and frequent hilar lymphadenopathy. Prior to the age of 5, sarcoidosis reveals more frequently with the classical triad of rash, arthritis, and uveitis. Due to non-specific clinical features and the lack of a specific test, recognizing sarcoidosis can be difficult in the pediatric population. Moreover, unlike in adults, lung involvement is rare in pediatric sarcoidosis. Given the lack of a definitive blood test, the World Association of Sarcoidosis and Other Granulomatous disorders (WASOG) only recommends dosing the serum angiotensin-converting enzyme (ACE). Its level is usually higher in children than in adults, but an increased ACE may help in the diagnosis. The gold standard is a biopsy specimen with typical epithelioid gigantocellular granuloma without caseating necrosis granuloma, after other disorders known to cause granulomatous disease have been reasonably excluded. We report here the case of a 4.5-year-old male with the history of polyarthritis and uveitis, considered first as juvenile rheumatoid arthritis, followed 5 years later by cutaneous involvement, which led to reconsidering the diagnosis. There were no pulmonary clinical findings. Histology provided the diagnosis of sarcoidosis. He then developed dependence on steroids. The lack of the classical triad delayed the diagnosis several years. This case shows the pediatric singularity of sarcoidosis, which needs to be known so that early and appropriate follow-up can be conducted.

Schistosoma hematobium -associated glomerulopathy

Schistosomiasis is the second most devastating tropical parasitic disease worldwide and is responsible for many urological complications. However, glomerular injury is a rare complication mainly described with Schistosoma mansoni. We report a case of membranoproliferative glomerulonephritis (MPGN) associated with Schistosoma hematobium infection in a young Senegalese boy living in a rural area. Clinical presentation was with steroid-resistant with nephrotic syndrome. Renal biopsy showed type 1 MPGN with the presence of S. hematobium eggs surrounded by a gigantocellular granuloma. Despite therapy with antihelminthic and immunosuppressive drugs, evolution was characterized by progression to end-stage renal disease over 1 year. More efforts should be made on the prevention and early detection of schistosomiasis among at-risk populations.

Biopsie conjonctivale : une aide précieuse pour le diagnostic de sarcoïdose

To highlight the advantages of conjunctival biopsy in order to confirm the diagnosis of sarcoidosis. A 78-year-old woman presented with unilateral vitreitis. The examination of the conjunctive of right and left eyes revealed multiple, translucent, pale yellow nodules the size of millet grains located in the lower fornix. The diagnosis of sarcoidosis was suspected by an increased level of angiotensin-converting enzyme and bilateral hilar lymphadenopathies. A biopsy from conjunctival nodules showed noncaseating epithelioid and gigantocellular granulomas, confirming the diagnosis of sarcoidosis. Although underused, conjunctival biopsy seems to be both a safe and effective tool in the diagnosis of sarcoidosis.

Sarcoïdose au cours du traitement de l’hépatite C par interféron alpha et ribavirine : deux cas

Introduction. – Interferon-alpha (IFNα) used to treat chronic hepatitis C can be responsible for some side effects. We report two cases of sarcoidosis which appeared in patients treated with IFNα and ribavirin for chronic hepatitis C. Exegesis. – A first patient, treated for 5 months with IFNα and ribavirin because of chronic hepatitis C, after the failure of a first treatment with IFNα alone, was hospitalized for dyspnea. The chest X-ray and scanner revealed an interstitial syndrome and mediastinal adenopathies. Biopsies of bronchial spurs revealed epithelioid and giganto-cellular granuloma. After discontinuation of antiviral treatment and starting corticosteroid therapy, the evolution was favourable but viremia reappeared. A second patient with IFNα and ribavirin for 4 months because of chronic hepatitis C (after the failure of a first treatment with IFNα alone) was hospitalized for fever, arthralgias, erythema nodosa and modification of previous skin scars. The biopsy of a scar showed an epithelioid and giganto-cellular granuloma. After discontinuation of antiviral therapy and starting corticosteroid treatment, the evolution was favourable. Conclusion. – Some publications mention occurrence of sarcoidosis during IFNα therapy, occasionally associated with ribavirin, disappearing after discontinuation of the treatment, though sometimes corticotherapy is necessary. The roles of IFNα and ribavirin are discussed.

Hepatitis G virus infection among liver graft recipients: anatomoclinical correlations.

Hepatitis G virus (HGV) causes persistent infection in man, but its disease association is controversial. We studied the HGV disease association in 25 liver transplantation (LT) recipients without evidence of hepatitis B and C infection. HGV RNA was tested by semiquantitative RT-PCR in serial serum samples and its presence was correlated with the biochemical and histological evidence of liver damage. The overall prevalence of HGV infection in this population was 9/25 (36%), one patient being HGV RNA positive since before LT, while the other eight apparently acquired de novo infections after LT. In five cases, appearance of HGV was followed by biochemical and histological evidence of liver damage: the liver biopsy showed acute rejection in two cases, acute cholangitis in two, and acute hepatitis in one. At the end of follow-up, histological evidence of chronic hepatitis was found in one HGV-positive patient but also in three HGV-negative patients, whereas the only patient with acute hepatitis at the time HGV RNA was first detected in serum developed an intralobular gigantocellular granuloma. In conclusion, HGV infection after LT may be seldom associated with acute and chronic liver damage, but comparable histological features can be observed also among HGV-negative controls.