Histiocytic Reaction Research Articles

#2633 Navigating complexity: a case report of chronic kidney disease with renal stone unravelling a rare metabolic disorder

Abstract Clinical Presentation A 48-year-old female of Asian heritage was referred for renal assessment after experiencing recurrent acute kidney injury (AKI) with incomplete recovery between episodes. This was initially attributed to dehydration and interstitial nephritis stemming from long-standing vomiting, a manifestation of gastroscopy-proven erosive gastritis, compounded by the use of high-dose proton pump inhibitors (PPI). Her relevant medical history is of right nephrectomy in 1996 due to recurrent urinary tract infections (UTIs), and previous left renal calculus in 2019 with no visible stones on further CT imaging. Despite living with a single kidney, her baseline eGFR had been normal prior to referral. While unaware of her mother's medical history, her father was recently diagnosed with kidney disease (no clear history) and her sister Wilson's disease. A kidney biopsy was undertaken given the incomplete eGFR recovery between episodes. The biopsy revealed adequate tissue including 24 glomeruli, no significant glomerular pathology was seen. There is 65% tubulointerstitial atrophy and fibrosis, and yellow to red-brown-tinged crystals within tubular lumina and epithelial cells, prompting a histiocytic reaction. These crystals were birefringent under polarized light and did not stain with Perl's and Von Kossa stain (Fig. 1a-d). Immunofluorescence was negative for all immunoglobulins and complement fractions. No immune complex/substructure deposits were seen in the glomeruli on electron microscopy. Blood tests assessing APRT activity indicated values within the carrier range (Table 1). The patient and her family have been referred for a comprehensive genetic testing for APRT genetic mutations. Treatment with Allopurinol 300 mg daily resulted in a sustained eGFR improvement from 19 to 33 ml/min/1.73m2 at 6 months after initiation (Fig. 1). Discussion Adenine phosphoribosyl transferase (APRT) deficiency, also known as Dihydroxyadenineuria, is a rare autosomal recessive inherited condition leading to kidney stones. If left untreated, up to 25% progress to end-stage kidney disease (ESKD). Although inherited, half of patient present in adulthood and may do so with laboratory findings of CKD rather than specifically with stones [1]. This case highlights the significance of precise diagnosis in calculi-related kidney diseases. Early intervention can alter the trajectory of specific conditions, averting progression to ESKD. This case is unusual in being a carrier of an autosomal recessive condition presenting with full manifestations of the disease. Patient Consent The patient has given verbal, documented consent for case publication. Acknowledgment We thank all renal and pathology staff members at Salford Care Organisation who contributed to the diagnosis and management of our case.

CASE REPORT: AN UNUSUAL CHEST WALL TUMOR REVEALING EXTRAPULMONARY THORACIC ACTINOMYCOSIS IN A CHILD

Actinomycosis is a granulomatous, suppurativebacterial condition caused by Actinomycesisraelii.The thoracic localization is rare it can simulate a neoplastic pathology or tuberculosis. We report one case of unusual presentation a 9-year-old girl. Admitted for the appearance of inflammatory pain of the right shoulder evolving for 6 months in a febrile context, marked by the appearance of a dorsal tumefaction. Radiological examination showed an osteolytic tissue mass of the lateral chest wall with pulmonary nodules and mediastinal lymphadenopathy. An Anatomopathological examination of the biopsy of the dorsal mass showed a histiocytic inflammatory reaction around grains of actinomycosis, allowing the diagnosis of thoracic-pulmonary actinomycosis. The patient was then put on antibiotic treatment with a good evolution. Thoracic actinomycosis is a rare infectious pathology, it can be radiologically divided into the chest wall involvement type, parenchymal type, the airway type including bronchiectasis, and the endobronchial form. The clinico-radiologicalpictureismisleading and maysimulate a tumoral or tubercular pathology, hence the need to repeat biopsies in search of characteristics of actinomyce.

18F]Fluorocholine PET/CT false positive: foreign body reaction mimicking anaplastic glioma progression. A case report

BackgroundForeign body reaction in brain tissue is a very rare immune response that has not been well studied. Hemostatic material has been reported as a possible trigger of this response in other organs and could be detected by [18F]fluorodeoxyglucose positron emission tomography/computerized tomography ([18F]FDG PET/CT), but there is no reported experience about the role of [18F]fluorocholine in this finding. [18F]Fluorocholine has the potential to differentiate viable central nervous system tumors from other entities, so it is frequently used in the follow-up of neurosurgery patients.Case presentationA right frontoparietal neoplastic lesion was found in a young-aged patient with analgesic refractory headache. Surgical resection and postsurgical radiotherapy were performed, and the pathologist analysis turned out a cellular ependymoma with signs of anaplasia. In the follow-up, an magnetic resonance imaging (MRI) showed a suspicious lesion, so a [18F]fluorocholine PET/CT was performed. Increased uptake was described in the right parietal region on the margin of the residual cystic lesion. The patient got a complete resection which was confirmed later by MRI. In the pathology analysis, a focally congestive cerebral parenchyma with a central histiocytic reaction to a foreign body area was described.ConclusionsFollowing the experience of the current case report, [18F]fluorocholine PET/CT could also show a false positive related to foreign body reaction. This entity should be considered to avoid unnecessary major surgery on our patients.

Histological findings of thyroid cancer after lenvatinib therapy.

Lenvatinib is a multikinase inhibitor used for treating unresectable or metastatic cancers, including thyroid cancer. As total thyroidectomy followed by radioactive iodine therapy is a commonly recommended initial treatment for thyroid cancer, histological findings of the thyroid after lenvatinib therapy remain unclear. Therefore, the aim of this study was to analyse in-vivo changes in patients who underwent thyroidectomy after lenvatinib therapy. We screened 167 patients with thyroid cancer [papillary thyroid cancer (PTC), n = 102; follicular thyroid cancer (FTC), n = 26; anaplastic thyroid cancer (ATC), n = 39] who underwent lenvatinib therapy. Among these patients, six underwent thyroidectomy (lenvatinib-treated group: PTC, n = 3; FTC, n = 1; ATC, n = 2), and the specimens were examined. Five patients with PTC who did not receive lenvatinib therapy were included for comparison (untreated group). Microvessel density (MVD) was evaluated in both groups. The PTC and FTC specimens showed relatively more ischaemic changes than ATC specimens. Coagulative necrosis and ischaemic changes in cancer cells were frequently observed. ATC specimens showed fibrosis and mild cell damage. As hypothyroidism is a common side effect of lenvatinib therapy, non-cancerous thyroid tissues were also examined. Histological findings included mild lymphocytic infiltration, lymphoid follicular formation, histiocytic reaction and follicular epithelial destruction. The MVD in lenvatinib-treated tissues was significantly lower than that in untreated tissues. Lenvatinib therapy probably induces relatively specific ischaemic changes in thyroid cancer cells. Moreover, inflammatory cell infiltration and decreased MVD occur to varying degrees in non-cancerous thyroid tissue and may be related to hypothyroidism, a side effect of lenvatinib.

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.

Pathological features of Brucella spondylitis: A single-center study

ObjectiveTo explore the pathological features of Brucella spondylitis (BS) under the optical microscope, thus providing pathological references for the diagnosis. MethodsWe retrospectively analyzed 70 BS patients (42 males and 28 females, mean age 52.01 ± 10.77 [20–74] years) admitted in the Department of Spine Surgery, the General Hospital of Ningxia Medical University, from January 2013 to December 2020. Their medical history, clinical manifestations, laboratory test results, imaging findings and bacteriological culture results were collected. Among them, 5, 5, 43, 4 and 13 cases demonstrated involvement into the cervical vertebra, thoracic vertebra, lumbar vertebra, thoracolumbar vertebra and lumbosacral vertebra, respectively. Notably, L4 showed pathology in 32 cases. Pathological features of BS were analyzed by H&E staining of granulation tissues, sclerotic bones, sequestrums, and intervertebral discs. Results42 cases underwent bacterial culture, of which 4 were positive, and the positive rate of bacterial culture was only 9.5%. The highest Vas score was 7, the lowest was 4, and the average was 5.76 ± 0.89. The highest CRP was 153 mg/L, the lowest was 0.98 mg/L, and the average was 30.98 ± 33.79 mg/L. The highest ESR is 112 mm/h, the lowest is 5 mm/h, and the average is 49.34 ± 27.73 mm/h. Under the optical microscope, BS manifested acute or chronic inflammation. Acute inflammatory features included neutrophil and eosinophil infiltration, necrosis, and abscesses, while chronic inflammatory features included lymphocyte, plasma cell, fibrous tissue and monocyte infiltration, hyaline degeneration, angiogenesis and hyperplasia of other tissues. Other features included vasodilation, hemorrhage, granulomas and multinucleated giant cell infiltration. In the present study, chronic inflammation was observed in 25 cases, in-acute-phase chronic inflammation in 45 cases, and acute inflammation in no cases. Pathological features of BS under the microscope included foam cell reaction in 46 cases, histiocytic reaction in 24 cases and eosinophilic abscesses in 6 cases. Eosinophil infiltration was observed in 45 cases (mainly during the acute phase of chronic inflammation) and massive eosinophilic abscesses in 6 cases. Granulation tissue hyperplasia followed inflammatory repair in 25 BS cases, and was generally boosted in the acute phase of chronic inflammation. Multinucleated giant cell infiltration and granulomas were less observed in BS cases, which differed from pathological features of spinal tuberculosis. ConclusionsChronic inflammation or in-acute-phase chronic inflammation is the main pathological feature of BS, while the single acute inflammation is less observed in BS cases. Foam cell reaction and histiocytic reaction scale up during the acute phase of chronic inflammation, and some BS patients may develop massive eosinophilic abscesses. Granulation tissue hyperplasia, rather than multinucleated giant cell infiltration and granulomas, serve as pathological reference for the differential diagnosis of BS and spinal tuberculosis.

Association of pathological response to neoadjuvant pembrolizumab with tumor PD-L1 expression and high disease-free survival (DFS) in patients with resectable, local-regionally advanced, head and neck squamous cell carcinoma (HNSCC).

6006 Background: Patients with resected HNSCC, with high-risk (positive margins, extracapsular spread [ECE]) or intermediate-risk pathological features have an estimated 1-year DFS of 65% and 69%, respectively. Immune checkpoint blockade improved survival of patients with recurrent/metastatic HNSCC, and preclinical models indicate radiotherapy (RT) synergizes with anti-PD-1. Therefore, we administered the PD-1 inhibitor pembrolizumab (pembro) pre- and post-surgery with adjuvant RT +/- cisplatin in patients with resectable, locoregionally advanced (clinical T3/4 and/or ≥2 nodal metastases) HNSCC (NCT02641093). Methods: Eligible patients received pembro (200 mg I.V. x 1) 1-3 weeks before resection. Adjuvant pembro (q3 wks x 6 doses) was administered with RT (60-66Gy) with or without weekly cisplatin (40mg/m2 X 6) for patients with high-risk and intermediate-risk features, respectively. The primary endpoint was 1-year DFS estimated by Kaplan Meier curves. Safety was evaluated by CTCAE v5.0. Pathological response (PR) to neoadjuvant pembro was evaluated by comparing pre- and post-surgical tumor specimens for treatment effect (TE), defined as tumor necrosis and/or histiocytic inflammation and giant cell reaction to keratinaceous debris. PR was classified as no (NPR, < 20%), partial (PPR, ≥20% and < 90%) and major (MPR, ≥90%). Tumor PD-L1 immunohistochemistry was performed with 22c3 antibody and reported as combined positive score (CPS). Results: Ninety-two patients were enrolled. Seventy-six patients received adjuvant pembro and were evaluable for DFS. Patient characteristics included: median age 58 (range 27 – 80) years; 32% female; 88% oral cavity, 8% larynx, and 3% human papillomavirus negative oropharynx; 86% clinical T3/4 and 65% ≥2N; 49 (53%) high-risk (positive margins, 45%; ECE, 78%); 64% (44/69 available) had PD-L1 CPS ≥1. At a median follow-up of 20 months, 1-year DFS was 67% (95%CI 0.52-0.85) in the high-risk group and 93% (95%CI 0.84-1) in the intermediate-risk group. Among 80 patients evaluable for PR, TE scoring resulted in 48 NPR, 26 PPR and 6 MPR. Patients with PPR/MPR had significantly improved 1-year DFS when compared with those with NPR (100% versus 68%, p = 0.01; HR = 0.23). PD-L1 CPS ≥ 1 was not independently associated with 1-year DFS, but was highly associated with MPR/PPR (p = 0.0007). PPR/MPR in PD-L1 CPS < 1, ≥1 and ≥20, were estimated as 20, 55 and 90%, respectively. Grade ≥ 3 adverse events occurred in 62% patients with most common including dysphagia (15%), neutropenia (15%), skin/wound infections (10%), and mucositis (9%). Conclusions: PR to neoadjuvant pembro is associated with PD-L1 CPS≥1 and high DFS in patients with resectable, local-regionally advanced, HNSCC. Clinical trial information: NCT02641093.

Xanthogranulomatous cholecystitis: Diagnosis and management

Xanthogranulomatous cholecystitis(XGC) is a rare form of cholecystitis, characterized by the presence of xanthogranuloma, prominent yellow structures within the gallbladder wall that is very often lithiasic. When XGC presents in its pseudo-tumoral form with occasional adjacent organ involvement, it can mimic gallbladder carcinoma (GBC). The etiopathogenesis of XGC is inflammatory destruction of Rokitansky-Aschoff sinuses containing biliary and cholesterol pigments within the gallbladder wall; this leads to a florid granulomatous histiocytic inflammatory reaction. The prevalence ranges from 1.3% to 8.8% of all cholecystectomies and varies from country to country; XGC occurs predominantly in patients over 50 years of age, and is equally distributed between males and females. Its association with GBC remains a topic of debate in the literature (between 0 and 20%). Symptoms are non-specific and generally similar to those of acute or chronic cholecystitis. XGC, when associated with altered health status, leads to the suspicion of GBC. XGC can also come to light due to an acute complication of cholecystolithiasis, in particular, gallstone migration. Imaging by sonography and CT scan is suggestive, but magnetic resonance imaging is more specific. In difficult cases, biopsy may be necessary to eliminate the diagnosis of tumor. In case of pre- or intra-operative diagnostic doubt, the opinion of a hepatobiliary specialty center can be of help. When diagnosis of GBC has been eliminated, laparoscopic cholecystectomy is recommended, although with a high risk of conversion to laparotomy and complications.

“BLACK-MARKET” COSMETIC INJECTIONS IN A TRANSGENDER FEMALE RESULTING IN SILICONE EMBOLI SYNDROME AND INTERSTITIAL LUNG DISEASE

SESSION TITLE: Fellows Diffuse Lung Disease SESSION TYPE: Fellow Case Reports PRESENTED ON: October 18-21, 2020 INTRODUCTION: A thrombotic pulmonary embolism is a commonly encountered diagnosis that is often on the forefront of our minds when evaluating a patient with dyspnea. In direct contrast, nonthrombotic emboli are less frequently encountered, span a diverse set of etiologies, and involve varied pathogenesis, other than traditional mechanical obstruction as with ordinary pulmonary emboli. Septic, fat, talc, venous air, amniotic fluid, tumor, iodinated oil, mercury, hydatid, cotton, and catheter have all been described as different emboli involving the pulmonary circulation. We report a case of cosmetic injections with silicone and mineral oil in a transgender female resulting in silicone emboli syndrome and subsequent interstitial lung disease (ILD) and worsening hypoxia. CASE PRESENTATION: A 40 year old transgender female presented to our hospital with worsening dyspnea, cough, and hypoxemia over the course of a year. Her medical history was notable for multiple silicone and mineral oil cosmetic injections to her breasts, thighs, and buttocks, which the patient described as “black-market procedures.” The patient was hypoxic on presentation, requiring 3L of oxygen via nasal cannula, but otherwise was hemodynamically stable and afebrile. Her physical examination and laboratory studies were unremarkable. A chest radiograph revealed peripheral bibasilar reticular opacities. A CT chest showed diffuse reticulation, interlobular septal thickening, scattered nodules, and ground glass opacities. A bronchoscopy with bronchioalveolar lavage and transbronchial biopsies was performed. Pathology revealed spheroid silicone particles in the lung interstitium and capillaries, with histiocytic reaction and fibrosis. The diagnosis of interstitial lung disease due to silicone embolism syndrome was granted. The patient was trialed on steroids, without improvement in symptoms. She was discharged with supplemental oxygen with referral for lung transplant evaluation. DISCUSSION: Following subcutaneous injection, often from cosmetic procedures by nonmedical practitioners, liquid silicone enters the pulmonary circulation. Once in the pulmonary capillaries, interstitial inflammation, increased vascular permeability, alveolar edema and hemorrhage can ensue. Clinical features include hypoxia, dyspnea, fever, alveolar hemorrhage, and cough, with both acute and chronic presentations. CT findings of reticulonodular opacities and interlobular septal thickening are suggestive. Histopathology reveals globular deposits, alveolar inflammatory infiltrates, fibrosis, and hemorrhage. Treatment with steroids has been reported with favorable outcomes, however, severe cases can lead to ARDS and death. CONCLUSIONS: This case highlights the importance of a thorough exposure history when evaluating patients with ILD. Additionally, it is imperative to promote the awareness of this potentially lethal complication of cosmetic silicone injections. Reference #1: Zamora, A.C., Collard, H.R., Barrera, L. et al. Silicone Injection Causing Acute Pneumonitis: A Case Series. Lung 187, 241–244 (2009) Reference #2: Dawn, Samuel K. MD*; Elicker, Brett M. MD*; Leung, Jessica W. T. MD†; Reddy, Gautham P. MD, MPH*; Gotway, Michael B. MD‡ The Silicone Syndrome, Clinical Pulmonary Medicine: March 2006 - Volume 13 - Issue 2 - p 146-147. Reference #3: Sridhara S, Baksh M, Batool K, Chowdhury J, Reddy V, Norwood S, Sivaswami S. A rare case of delayed chronic pneumonitis following non-medical grade silicone injections in a transgender woman. J Unexplored Med Data 2018;3:1. DISCLOSURES: No relevant relationships by Astrid Carrion Rodriguez, source=Web Response No relevant relationships by Andrew Daya, source=Web Response No relevant relationships by Christine Girard, source=Web Response No relevant relationships by Nydia Martinez, source=Web Response No relevant relationships by Rajaganesh Rajagopalan, source=Web Response

A colonic mass revealing a disseminated crystal storing histiocytosis secondary to indolent multiple myeloma: a case report with literature review

BackgroundCrystal storing histiocytosis is a rare disorder associated with monoclonal gammopathy. In this disease, monoclonal heavy and light chains accumulate in the lysosome of macrophages, leading to histiocytic reaction in different organs. It is secondary to the presence of a small B-cell clone, responsible for monoclonal immunoglobulin production. Histological diagnosis is a challenge and differential diagnoses include fibroblastic and histiocytic neoplasm. Clinical manifestations depend on the involved organs, rarely including peritoneum or digestive tract.Case presentationWe present a case of a 75-year-old with a medical history of colonic carcinoma. She presented with abdominal pain and inflammatory syndrome revealing a colonic mass. Hemicolectomy was performed. Initial diagnosis was fibroblastic tumour. The patient worsened, and diagnosis of a diffuse crystal storing histiocytosis was finally done. Haematological exploration found an indolent IgG-kappa multiple myeloma. The initial treatment with conventional chemotherapy did not permit an improvement of the patient condition. Immunotherapy with anti-CD38 monoclonal antibody (daratumumab) was proposed with a clinical and biological response.ConclusionThis case report emphasizes the histopathological challenge of histiocytic tumours which may involve digestive track. It focuses on the concept of monoclonal gammopathy of clinical significance, which can have a large spectrum of manifestations.

Histopathology of Red Tattoo Reactions.

Despite popularity of tattoos, complications may occur. In particular, red tattoo reactions due to allergic reactions are the most frequent chronic tattoo reactions. However, little is known about its histopathology and underlying pathomechanisms. The aim of this article is to analyze the histopathology of red tattoo reactions for diagnostic purposes and to acquire more insight into pathogenesis. A retrospective cross-sectional study was conducted by reviewing the histopathology of 74 skin biopsies of patients with allergic red tattoo reactions. Histopathological findings, such as inflammation patterns, inflammatory cells and pigment depth and color, were semi-quantified with an in-house validated scoring system by 2 independent senior investigators. Histiocytes and lymphocytes were both present in >93%. Histiocytes were the predominant inflammatory cells in 74.3%, but well-defined granulomas were mostly absent (78.0%). Eosinophils were uncommon (8.1%) The predominantly histiocytic reaction combined with interface dermatitis was the main inflammation pattern (37.9%). Most biopsies showed more than one reaction pattern. Interface involvement was observed in 64.8%, despite the intended depth of standard tattoo procedures, in which pigment is placed deeper, in the upper- and mid-dermis. Statistical analyses showed a significant association between inflammation severity and pigment depth (P = 0.024). In 6 cases (8.1%) pigments could not be retrieved histologically. In this cohort we demonstrated that cutaneous reactions to red tattoo ink are frequently characterized by the combination of dermal predominantly histiocytic infiltrates and epidermal interface dermatitis. Allergic reactions to red tattoo pigments probably represent a combination of a subtype IVa and IVc allergic reaction. Clinicians should be aware of the specific histopathology of these reactions and therefore the importance of taking a diagnostic skin biopsy.

Lanthanum Deposition in the Gastroduodenal Mucosa of Dialysis Patients.

Lanthanum (La) carbonate (LC) is one of the most popular phosphate binders used in dialysis patients with end-stage renal disease. Only a small amount of LC is believed to be absorbed from the gastrointestinal (GI) tract because LC strongly binds to dietary phosphate and forms insoluble complexes. La deposition in the gastroduodenal mucosa has been recently identified. Endoscopically, La deposition is demonstrated as whitish lesions of varying sizes and shapes in the gastroduodenal mucosa. Microscopically, La deposition is characterized by histiocytic reaction or small foreign body granulomas containing gray or brown materials mainly in the lamina propria of the GI mucosa. Some histiocytes containing La can migrate into regional lymph nodes via the lymphatic flow. The amount of La deposition in the gastroduodenal mucosa is correlated with the total dose of LC administration, and La deposition is almost consistently observed in LC-treated dialysis patients. Although the detailed mechanism of La deposition in the GI tract is still unclear, several factors, such as gastric pH and metaplastic change of the mucosal epithelium, may be involved in the La deposition in the gastroduodenal mucosa. Here we present an overview of the feature of La deposition in the GI tract.

Phosphoglyceride crystal deposition disease in the abdominal wall: a case report

BackgroundPhosphoglyceride crystal deposition disease (PGDD) is characterized by phosphoglyceride crystal deposition that simulates neoplasia in soft tissue scars or bone. Reports of PGDDs are rare. Here, we present the case of a patient with PGDD in the abdominal wall.Case presentationA 57-year-old Japanese man with worsening right lower abdominal pain had no significant family or occupational history. Laboratory data showed elevated inflammatory markers with a white blood cell count of 14,400 × 109/L and C-reactive protein of 11.8 mg/L, but no other abnormalities. Helical computed tomography (CT) revealed a tumor in the abdominal wall (longest dimension, approximately 10 cm). Positron emission tomography–CT revealed fluorodeoxyglucose accumulation in the mass only (SUVmax, 41). Clinical and radiographic findings suggested malignant lymphoma, undifferentiated sarcoma, or liposarcoma. He underwent exploratory laparotomy and further treatment. At surgery, we found a huge milky-whitish mass with a rough surface in the transversus abdominis. Complete resection was performed and his postoperative recovery was good. Surprisingly, the final pathologic diagnosis was phosphoglyceride crystal deposition disease with the characteristic crystal deposition in a corolla shape, histiocytic reaction with abundant foreign-body-type giant cells, and no evidence of neoplasia. The patient remains asymptomatic with no disease recurrence.ConclusionAlthough phosphoglyceride crystal deposition disease in the abdominal wall is rarely encountered in clinical practice, its inclusion in differential diagnosis is important. Given the occurrence at sites of invasive procedures, we believe efforts to reduce invasiveness when performing surgery and follow-up for early detection of recurrence are important.

Comparison of Elastane Fiber with Polyprolene and Polyglecaprone 25 used as Surgical Suture Material: an experimental preliminary study

Aim: Elastane fiber is a synthetic monofilament polymer which is durable and highly flexible. In this preliminary study we compared Elastane fiber with polypropylene and polyglycaprone 25, surching the inflammatory reaction in the rat soft tissue, considering that it could be used for sternal closure because of its properties. Material and Methods: Elastane fiber, polypropylene and polyglycaprone25 sutures were placed in 3 separate areas at 2 cm intervals in the subcutaneous tissue of each 8 male wistar albino rats without any incision, using the seldinger method. After two weeks, the rats were sacrified and tissue specimens, including the suture fragments, were resected. Histopathological scoring in terms of inflammation, vascularization, fibrosis and histiocytic reaction were achieved semiquantitatively. Results: There was no statistically significant difference between three suture materials in terms of inflammation (p=0.513), vascularization (p=0.065), fibrosis (p=0.108) and histiocytic reaction (p=0.630). Conclusion: As a conclusion elastane fiber showed similar inflammatory changes with other suture materials in the rat soft tissue which is thought to be useful for sternal closure due to its high flexibilityand durability.

Chondroblastoma-like chondroma of soft tissue: A report of two cases

Soft tissue chondroma is a benign cartilaginous neoplasm composed of cells with a chondroid phenotype. Chondromas of soft tissue can have variable histological appearances including deposition of calcium, histiocytic reaction, ossification, and myxoid change. One notable variation is the presence of histological features reminiscent of chondroblastoma of the bone, and the term used in this scenario is chondroblastoma-like chondroma of soft tissue. There have been fourteen previous case reports of chondroblastoma-like chondroma of soft tissue, predominantly in the hands; with one case being reported in the base of the skull. We report two cases of chondroblastoma-like chondroma of soft tissue occurring in the hand and foot. To the best of our knowledge this is the first reported case of chondroblastoma-like chondroma of soft tissue in the foot.

Histochemical features of aluminum chloride histiocytic reaction and the use of PAS stain to provide a clue to prior subtle biopsy sites.

Histochemical features of aluminum chloride histiocytic reaction and the use of PAS stain to provide a clue to prior subtle biopsy sites.

Feasibility of a polyethylene glycol-derived polymer as retinal patch to seal retinal breaks during vitrectomy for rhegmatogenous retinal detachment: a prospective, in vivo pilot study in a porcine model.

This is a pilot study to test a polyethylene glycol-derived polymer used as a retinal patch to seal retinal breaks during pars plana vitrectomy in the treatment of rhegmatogenous retinal detachment in a porcine model. Sixteen eyes from eight pigs were assigned to two study groups (12 eyes) and one control group (four eyes). In all study groups, the polymer was used in vivo, during pars plana vitrectomy, to seal the break of a surgically induced rhegmatogenous retinal detachment. Eyes in study groups were filled with balanced saline solution at the end of the surgery. In the control group, the polymer was not used and the eyes underwent standard rhegmatogenous retinal detachment repair with pars plana vitrectomy. All eyes underwent fundus examination at day 3, week 1 and week 2 after surgery. All eyes from all groups were enucleated and processed for qualitative histological evaluation. Intraoperatively, the polymer showed good adherence and compliance to the retina. At week 1, retina was attached in all cases. The polymer was visible with indirect ophthalmoscopy up to week 1. At week 2, the polymer was no longer visible. Histologically, a mild histiocytic reaction was noticed in the retinas of four out of 12 study eyes (33.3%). In the control eyes, non-specific inflammatory signs of retinal inflammation were reported in two out of four eyes (50%). This study provides initial data to support the use of this polymer as a promising alternative to standard endo-tamponade agents. Its safety and biocompatibility need to be further assessed.

Atypical Incidental Presentation of Thymolipoma With Macroscopic Appearance Suggestive of Malignancy in Patient Undergoing Coronary Artery Bypass Grafting

Purpose: We report the incidental finding of a thymolipoma in a 61-year-old male undergoing urgent CABG with intra-operative findings suggestive of malignant progression. Methods: A 61-year-old male undergoing urgent CABG for triple vessel disease was noted to have a large anterior mediastinal mass upon primary median sternotomy. The 5 cm mass appeared to be infiltrating the SVC, left innominate vein junction and pericardium, with the appearance highly suggestive of malignancy. Given this, and to ensure full oncological clearance, the mass and infiltrated pericardium was excised along with the wall of the SVC and innominate vein which was subsequently repaired using a bovine pericardial patch. Following this, CPB was introduced via 2-stage cannulation and routine coronary artery bypass grafting was performed using LIMA and vein grafts. Results: The patient required a prolonged period of postoperative ventilatory support before being extubated day 4 and went on to have an uneventful recovery. Anatomical histopathology demonstrated the mass was a benign thymolipoma with significant infarction with necrosis and florid histiocytic reaction accounting for the malignant macroscopic appearance. No further follow-up was required. Conclusions: Histiocytic reaction in an infarcting anterior mediastinal thymolipoma can present with macroscopic changes highly suggestive of a malignant process in an otherwise benign lesion.

Novel Bioceramic Urethral Bulking Agents Elicit Improved Host Tissue Responses in a Rat Model.

Objectives. To test the physical properties and host response to the bioceramic particles, silica-calcium phosphate (SCPC10) and Cristobalite, in a rat animal model and compare their biocompatibility to the current clinically utilized urethral bulking materials. Material and Methods. The novel bulking materials, SCPC10 and Cristobalite, were suspended in hyaluronic acid sodium salt and injected into the mid urethra of a rat. Additional animals were injected with bulking materials currently in clinical use. Physiological response was assessed using voiding trials, and host tissue response was evaluated using hard tissue histology and immunohistochemical analysis. Distant organs were evaluated for the presence of particles or their components. Results. Histological analysis of the urethral tissue five months after injection showed that both SCPC10 and Cristobalite induced a more robust fibroblastic and histiocytic reaction, promoting integration and encapsulation of the particle aggregates, leading to a larger bulking effect. Concentrations of Ca, Na, Si, and P ions in the experimental groups were comparable to control animals. Conclusions. This side-by-side examination of urethral bulking agents using a rat animal model and hard tissue histology techniques compared two newly developed bioactive ceramic particles to three of the currently used bulking agents. The local host tissue response and bulking effects of bioceramic particles were superior while also possessing a comparable safety profile.

Eosinophilic Metallosis: A Newly Described Entity in Failed Metal-on-Metal Arthroplasty.

In recent years, metal-on-metal (MoM) orthopaedic implants have been associated with significant adverse tissue reactions, prompting revision surgeries and recalls by manufacturers. Adverse tissue reactions consist of a wide range of pathologic findings but are generally characterized by a histiocytic reaction to metal debris, with or without an inflammatory response. Inflammation is generally that of a lymphocytic infiltration that prompts concern of an immune reaction. Only occasionally have eosinophils been documented-never as a marked infiltrate. In this article, we present the first histologic description of a dominant eosinophilic infiltrate associated with MoM arthroplasty. In our case report, the patient is a 53-year-old woman who presented with recurrent fluid collections surrounding the hip after a MoM total hip arthroplasty. At the time of surgical revision, tissue samples were taken and found to consist of lymphocytes and a prominent infiltrating eosinophilia. To our knowledge, no factors predictive of this type of tissue response have been identified, and its significance remains unclear despite ongoing research about the nature of the immune response to metal. Future work may help to elucidate whether the type and significance of this response can be predicted preoperatively and modulated, if necessary, postoperatively.