Histological Picture Research Articles

Esophageal Lichen Planus as a Cause of Dysphagia: Literature Review and Clinical Observation

Aim: to analyze the literature data, and to raise awareness of doctors of various specialties about the methods of diagnosis and treatment of esophageal lichen planus (ELP).Key points. In a 67-year-old female patient with complaints of difficulty swallowing solid food and weight loss, esophagogastroduodenoscopy revealed subcompensated stenosis of the middle third of the esophagus and signs of fibrinous esophagitis. Based on the characteristics of the endoscopic picture and the detection of apoptotic Ciwatt bodies in esophageal biopsies, a diagnosis of ELP was established. Treatment with glucocorticosteroids led to relief of symptoms and positive endoscopic dynamics. ELP is rare and the least studied, data on this disease in the literature are presented mainly in the form of clinical observations and analysis of series of cases. Typical clinical manifestations include dysphagia and odynophagia. Despite the low prevalence, ELP can be associated with serious complications: stenosis and esophageal squamous cell carcinoma. Endoscopic examination reveals characteristic signs in the esophagus: swelling, thickening and increased vulnerability of the mucosa, often with fibrin, formation of membranes and strictures. The histological picture is represented by epithelial dyskeratosis with exfoliation, lichenoid lymphocytic infiltration. The most specific histological sign is the presence of apoptotic Civatte bodies. Recommendations for the treatment of ELP are limited to the results of a series of clinical observations and include the prescription of systemic corticosteroids. The issue of supportive therapy is the least studied.Conclusion. Analysis of the literature data and the clinical case demonstrate that lichen planus of the esophagus is one of the rare causes of dysphagia. Characteristic endoscopic and histological signs are key for the diagnosis. The management of patients with esophageal lichen planus is insufficiently defined and today includes taking of glucocorticosteroids, endoscopic dilation of stricture and dynamic endoscopic observation, given the high risk of squamous cell carcinoma in this category of patients.

Angiotensin(1-7) attenuates tooth movement and regulates alveolar bone response during orthodontic force application in experimental animal model

BackgroundRenin–angiotensin system and its ACE2/Ang(1-7)/Mas receptor axis regulates skeletal response to multiple physiological and pathological conditions. Recent research suggested a vital role of Ang(1-7) in regulating alveolar bone metabolism and remodeling. In this context, this study evaluated the effects of the Ang(1-7)/Mas receptor axis on orthodontic tooth movement (OTM) and the alveolar bone response to mechanical load.MethodsA coil spring was placed between the right maxillary first molar and the anterior tooth of Wistar rats to apply bidirectional mechanical force. Ang(1-7) with or without a specific Mas receptor antagonist (A779) was infused using subcutaneous osmotic pumps (200 and 400 ng/kg/min: respectively). Animals were killed after 5 and 14 days from the OTM procedure after the clinical evaluation of tooth movement and mobility. Morphometric analysis of alveolar bone structure was conducted using micro-CT and the histological picture was evaluated after H&E staining. Moreover, collagen fiber distribution was assessed using Picro-Sirius red stain. In addition, bone samples were collected from the pressure and tension sites around the anterior tooth for gene expression analysis.ResultsAng(1-7) infusion suppressed the tooth movement and mobility after 14 days of the orthodontic force application. Additionally, Ang(1-7) infusion preserved the morphometric and histological structure of the alveolar bone at pressure and tension sides. These effects were abolished by adding A779 infusion. Collagen fiber distribution was dysregulated mainly by the A779 Mas receptor blockage. Ang(1-7) affected the bone formation, remodeling- and vascularity-related genes in the pressure and tension sides, suggesting a prominent suppression of osteoclastogenesis. Ang(1-7) also improved osteoblasts-related genes on the tension side, whereas the osteoclasts-related genes were augmented by A779 on the pressure side.ConclusionCollectively, the activation of Ang(1-7)/Mas receptor axis appears to hinder tooth movement and regulates alveolar bone remodeling in response to mechanical force.Graphical abstract

HISTOLOGICAL RESPONSE OF PULP TO BELIMBING WULUH (Averrhoa bilimbi L.) GEL COMPARED TO CARBAMID PEROXIDE AS TOOTH WHITENING (IN VIVO)

A teeth whitening procedure is an action to get naturally bright teeth color. The teeth whitening process often has side effects on the tooth structure and its surroundings. Teeth whitening ingredients generally contain carbamide peroxide. One of the natural ingredients that can whiten teeth is Averrhoa bilimbi Linn. This study aimed to determine the effect of Averrhoa bilimbi L. gel and carbamide peroxide on the histological response of the pulp. The research method was carried out by processing Averrhoa bilimbi Linn into extracts through the maceration method and then making a gel with a concentration of 50%. The study was conducted on 27 rabbit incisors and divided into three groups (negative control group, 10% carbamide peroxide, and 50% Averrhoa bilimbi L. gel). Each group was exposed for 4 hours for 14 days, then the teeth were extracted, and the pulp was taken with K-file number 10-40 and continued to look at the histological picture. The data was processed using a one-way ANOVA statistical test; the statistical test results showed significant differences for the three groups with a p-value of 0.000 (p <0.05). It can be concluded that there is an effect of 50% Averrhoa bilimbi L. gel on the histological response of the pulp, there is an effect of 10% carbamide peroxide on the histological response of the pulp, and there is a significant difference between 10% carbamide peroxide and 50% Averrhoa bilimbi L. gel.

Effect of Uneven Microclimates in Poultry Yards on the Respiratory System of Poultry

The respiratory system of birds is maximally adapted to the high efficiency of air exchange necessary to maintain an increased level of metabolic processes. The mucus of the respiratory tract plays an important role in mucociliary clearance, in the normal state of the respiratory system, without allergic and inflammatory reactions, an increase in the amount of mucus and the structures that produce it can be interpreted as a positive fact, but too much mucus can be a response to mucosal irritation and contributes to airway obstruction. As a result of two studies repeating each other, the dependence of the state of the tracheal wall in Ross-308 cross broilers on air circulation in industrial premises was confirmed. Ensuring the circulation of air flows in poultry rearing halls has a positive effect on the histological and histochemical structure of the trachea. In the first experiment, this is reliably evidenced by an increase in the thickness of the epithelial layer by 1.3 times (by 23.3%) and the height of the cilia by 3.1 times (by 67.5%). In the second experiment, this is confirmed by an increase in the height of the epithelium by 40% and the height of the cilia layer by 70%. In addition, the histological picture of the mucosa corresponds to the norm, there are no violations of the integrity of the epithelium, the cilia are smooth, without deformations and creases. With the provision of air circulation in closed rooms in the first experiment, the thickness of the tracheal mucosa decreases by 2.6 times (by 61.9%), and its own plate by 2.9 times (by 65.4%). In the second experiment, no such pattern was found in the own plate, but destructive changes in the tracheal mucosa, an increase in the number of glycoproteins and proteoglycans in the experimental groups confirm the influence of the ventilation factor.

The Effect of Nitroglycerine on Myocardial Injury Induced by Ischemia/Reperfusion in Adult Male Albino Rats

Abstract Background Despite, early reperfusion is the current optimal way to rescue the heart and salvage of greater amount myocardium, the process of reperfusion could induce myocardial injury and cardiomyocyte death, that result in heart failure and death. Several therapeutic medications such as nitroglycerine is currently under investigation for preventing myocardial reperfusion injury which has the potential to improve clinical outcomes in patients with acute myocardial infarction treated Aim of the Work To investigate the effect of nitroglycerin on myocardial ischemic reperfusion injury as regard histopathological changes. Materials and methods 30 Male adult albino rats were randomly divided into four groups (10 rats for each); Group I (2 subgroups: group 1A (control group) & group 1B (sham group)). Group II (ischemia/reperfusion animal model). Group III (nitroglycerine 0.5 mg/kg BW 15 min before I/R). Tissue samples of heart ventricles of all animals were collected and processed for light microscopic examination. Results The ischemia /reperfusion group showed massive disruption of the normal histological cardiac muscle picture, interstitial hemorrhage, inflammatory cells infiltration, pyknotic changes in the nuclei and dark acidophilic contraction bands. Nitroglycerine treated group revealed disruption of cardiac muscle fibers and with minimal improvement in the histological appearance. Conclusion Nitroglycerine injection attributed to potential improvement for myocardial ischemia reperfusion injury which. Therefore, it might be assumed that nitroglycerine could be used as a safe drug before induction of reperfusion.

Differential diagnoses of benign eyelid tumors in children and adolescents

The clinical diagnosis as well as the treatment approach of periocular tumors in childhood and adolescence can be challenging. Knowledge of the most important differential diagnoses and their clinicopathological correlation is helpful for the treatment approach. The clinical and histological characteristics of various eyelid tumors in childhood and adolescence are presented taking the excision frequencies into consideration. The frequencies and clinicopathologic correlation of the most important eyelid tumors (n = 485) are presented based on the data of the ophthalmopathology laboratory of the University Eye Hospital Bonn from 1998-2023. The most frequent tumor in childhood and adolescence is chalazion (57.3%), followed by dermoid cysts (16.7%) and molluscum contagiosum (9.6%). Other lesions of childhood and adolescence include pilomatrixoma (2.1%), hemangioma and other vascular malformations (4.7%) and rare differential diagnoses, such as subcutaneous calcifying nodules and xanthogranuloma. Guidance on the approach in different age groups is presented in the form of adecision tree. Tumors in children and adolescents are mostly benign, yet there are important indications for excision. A histological examination of any excised tissue in childhood and adolescence is obligatory because unexpected findings are not uncommon and the spectrum of lesions also differs from that in adulthood. Knowledge of the histological picture can be very helpful in the preoperative clinical classification and for planning further procedures.

Light and scanning electron microscopic study of the effects of platelet-rich plasma on dexamethasone-induced osteoporosis in adult male albino rats

Abstract Background Osteoporosis may occur by using glucocorticoids for a long time. Recently, platelet-rich plasma (PRP) is used in treating a wide variety of musculoskeletal problems. Aim This work aimed to study the effect of PRP against dexamethasone-induced osteoporosis in adult male albino rats. Materials and methods This study was carried out on 40 adult male albino rats that were divided into two main groups: control group I: included 10 rats and experimental group II included 30 rats, which were subdivided into three subgroups. Subgroup IIa received PRP, subgroup IIb was injected with dexamethasone intramuscularly, and subgroup IIc received the same dose of dexamethasone and then injected with PRP. At the end of the experiment, upper ends of femur bones of all animals were obtained and processed for histological study using light and scanning electron micrograph studies. Results Light microscopic examination revealed osteoporotic histological changes in group IIb where cancellous bone trabeculae appeared thin and discontinuous. Scanning electron micrograph studies confirmed the results of the light microscopic study. Group IIc revealed partial preservation of the normal histological picture. Statistical analysis showed that group IIb and untreated left femur of group IIc revealed a highly significant decrease in the mean thickness of trabeculae and a highly significant increase in the width of intertrabecular spaces as compared with the control group, while group IIa and treated right femur of group IIc revealed nonsignificant changes as compared with the control group. Conclusion Osteoporosis resulted from glucocorticoids in adult male albino rats could be partially treated with PRP injection.

Cytoprotectant Doctovit: perspectives of the use at acid-dependent gastroduodenal diseases

The paper presents analysis of publications devoted to the use of cytoprotectant Doctovit at acid‑dependent gastroduodenal diseases and prospects of its use at inflammatory and erosive injuries of the esophagus, stomach and duodenum. A pathogenetic substantiation of the expediency of using the Doctovit (a complex of vitamins U (methylmethionine) and B5 (dexpanthenol)) is presented for cases of erosive and ulcerative (Helicobacter pylori‑associated) gastroduodenal lesions and at NSAID‑gastropathy, as well as at preservation of inflammatory changes in the gastric mucosa after antihelicobacter therapy (posteradication syndrome). The mechanism of action of Doctovit components is described. The review of investigations has been presented that showed normalization of secretory stomach function (in particular due to vitamin U methylation of histamine and its transformation into an inactive form), faster ulcers’ healing, analgesic, gastroprotective, antioxidant and lipotropic effects, which contribute to the stimulation of healing of mucosal erosions and ulcers in the digestive tract, positive dynamics of the histological picture of the gastroduodenal mucosa in patients who received Doctovit as a part of complex therapy. The positive effects included decrease in the severity of inflammatory cellular infiltration of the mucosa own lamina, disappearance of lymphoid follicles due to improvement in the condition of the epithelium due to an increase in its compensatory reparative regeneration, improvement in the condition of the integumentary pit epithelium of the stomach after treatment and strengthening of its mucin‑producing function with improvement in the quality of mucus The expediency of further use of Doctovit in patients with acid‑dependent pathology of the digestive tract is substantiated.

CHONDROSARCOMA IN THE XXI CENTURY

Chondrosarcoma (CHS) is a rare oncopathology, is the third most common primary bone tumor after multiple myeloma and osteosarcoma. It accounts for about 25 % of the total number of bone sarcomas. CHS mainly affects adults and occurs more often in people older than 40 years, in children and adolescents it is less than 5 % of all cases of primary CHS. The most common CHS sites can be any bone containing cartilage, but most often this tumor is found in pelvis, femur and shoulder bones, and ribs. CHS are divided: by origin (primary and secondary), anatomical site (central — inside the bone marrow canal, peripheral — inside the existing osteochondroma, periosteal — on the bone surface), histological degrees GI-GII-GIII. The WHO classification (2020) includes central normal, secondary peripheral, periosteal, dedifferentiated, mesenchymal and clear-cell CHS. More than 90 % of conventional CHS are tumors of low and medium malignancy degree, with a low potential for metastasis. CHS is caused by mutations in genes that control bone growth and development. The main risk factors are the patientʼs age, previous radiation, genetic factors and predisposition to oncological diseases. Diagnosis of CHS is based on a complex algorithm, which involves collecting the patient's complaints, anamnesis, clarifying clinical symptoms, imaging (X-ray, CT, MRI), histopathological picture. The biopsy conclusion is the most important in establishing the final diagnosis. However, there are several tumors whose histological picture is similar to CHS: enchondroma, chondroblastoma, osteosarcoma, giant cell tumor of bone, dedifferentiated liposarcoma, synovial sarcoma. The CHS treatment protocol is determined based on the results of anamnestic data, imaging, histopathological results, CHS classification, and its final tumor subtype. The «gold standard» remains surgical removal of the tumor. Radiation and chemotherapy don’t play a significant role in the treatment of CHS, but require further study. Targeted and immunotherapy have a certain potential, even with a high degree of CHS resistance to traditional chemotherapy.

Primary angiosarcoma under the guise of constrictive pericarditis: a case report

Primary cardiac tumors are histologically heterogeneous and grow from the heart tissues. Their diagnosis is difficult due to the absence of pathognomonic signs, as well as the possibility of a long asymptomatic course. The authors present a case of late diagnosis of heart tumor in a young man, occurring under the guise of constrictive pericarditis with rapidly progressive heart failure, which ended in death 3 months after the first clinical symptoms. According to the autopsy, the histological picture and immunophenotype of the tumor corresponded to angiosarcoma.

Morphological structure of testicles under conditions of experimental gonadopathy and after the administration of cholecalciferol in comprehensive correction schemes

The problem of male infertility is relevant and calls for a solution. The use of the D3 vitamin in infertility treatment schemes has a potentially positive effect on reproductive health in male individuals. The present study aims to examine the effect of vitamin D3, administered alone or in combination with a preparation containing the extract of Tribulus terrestris on the changes in the histological picture of testicular morphology in rats with experimental gonadopathy. Male rats with modeled reproductive function pathology (Serotonin-induced gonadopathy) were divided into groups receiving correction using cholecalciferol alone or in combination with the reference drug Tribestan (Tr), which contains an extract of Tribulus terrestris. In addition to observational microscopy, morphometric evaluation of spermatogenesis was performed on sections of the testicles stained with hematoxylin and eosin. The statistical analysis was performed using the standard software package “Statistica 6.0” with the utilization of the Student’s t-test and its nonparametric counterpart, the Kruskal-Wallis test for one-way analysis of variance, followed by the Mann-Whitney test. It was found that the seminiferous tubules of rats with Serotonin-induced gonadopathy are significantly reduced in size, and their tunica propria is thickened. Sertoli cells are often destructively altered, and the uniformity of their arrangement is disrupted. A decrease in the weight of the gonads, epididymis, prostate gland, and hypoandrogenization was observed as well as a decline in spermatogenesis indicators. An improvement in the morphological characteristics of the gonads was noted following the administration of vitamin D3 in the presence of pathology. The seminiferous tubules had a normal histological structure. The germ cells were arranged in concentric rows according to their developmental stages, and the Sertoli cells appeared visually unchanged. The population of Leydig cells appeared visually more heterogeneous than in the control animals. However, occasionally seminiferous tubules with focal necrobiosis of germ cells and dystrophy of Sertoli cells, as well as a reduction in rows of germ cells, were observed. Overall, the quantitative indicators of spermatogenesis improved after the administration of vitamin D3 compared to rats with experimental gonadopathy, although they did not reach the levels of the intact control. The administration of a combination of vitamin D3 and Tribestan in the presence of gonadopathy resulted in a greater positive effect compared to their individual use. The microscopic condition of the testicular tissue in rats was fully recovered. The combined use of vitamin D3 with Tribestan normalized the weight of the gonads and their appendages, significantly reduced the manifestations in the histological sections of degeneration and damage in the reproductive cells during the period of growth and differentiation, improved the relative level of androgen status in the organism and had a positive effect on spermatogenesis in the gonads. Thus, we have established that the combined use of Сholecalciferol and Tribestan for correcting experimental gonadopathy was more effective than either of the mentioned components alone.

The Histomorphometry of The Small Intestine on Turkey (Meleagris Gallopavo) at Different Age Levels

This study aims to determine the histomorphometry of the small intestine of turkeys (Meleagris gallopavo) at different age levels. This study used a completely randomized design. This study used 18 male turkeys, divided into 3 groups of ages 8, 16, and 24 weeks, each group comprising 6 turkeys. The necropsied turkey's small intestine was taken into histological preparations and stained with haematoxylin-eosin (HE). The results showed that the histological picture of the small intestine layer of turkeys at different age levels consisted of four layers: tunica mucosa, tunica submucosa, tunica muscular, and tunica serosa. Histomorphometrically, there was an increase in the thickness of all layers of the small intestine from 8 and 16 weeks of age (P0.05), and the height of the intestinal villi increased in all parts of the small intestine at 8, 16 and 24 weeks of age (P0.05 ). In conclusion, with histomorphometric measurements, it can be seen that there are differences in the three age groups.

Classification Of Lung and Colon Cancer Histopathological Images Using Convolutional Neural Network (CNN) Method An A Pre-Trained Models

Cancer is a severe illness that can affect many young and older people. In Indonesia, lung cancer is the leading cause of cancer-related death, whereas colon cancer, with more than 1.8 million cases worldwide in 2018, is the third most common cancer. This study intends to create a model to categorize histological images of lung and colon cancer into five labels to aid medical professionals' categorization job. This study uses a pre-trained model idea known as VGG19 in its CNN (Convolutional Neural Network) technique. The dataset uses 25,000 histological graphic pictures with a ratio of 80% training data and 20% testing data. The classification system for lung and colon cancer contains five categories: lung benign tissue, lung adenocarcinoma, lung squamous cell carcinoma, colon adenocarcinoma, and colon benign tissue. The training result revealed a 99.96% accuracy rate and a 1.5% loss rate. The model can be rated as excellent based on these results

#4876 CLASSIFICATION OF BIOPSY FINDINGS IN INDIVIDUALS WITH NEPHROPATHIES USING MOLECULAR GENETIC TESTING AND PROTEOMICS

Abstract Background and Aims In approximately 10% of adults with chronic kidney disease, a hereditary cause can be identified. Important representatives are Alport syndrome and inherited podocytopathies, which often show the histological picture of focal segmental glomerulosclerosis (FSGS). FSGS is a histological finding of various etiologies (primary, hereditary, secondary). Especially in suspected glomerular kidney disease, kidney biopsy is the diagnostic gold standard. The aim of this study was to evaluate a cohort of individuals with genetically confirmed inherited nephropathy and previous kidney biopsy to determine whether the histological examination can provide a clue to the underlying inherited kidney disease. Biopsies were further investigated by proteomics via liquid-chromatography-mass spectrometry (LC-MS) to potentially elucidate the underlying protein defect. Method The cohort for this retrospective study consisted of 23 individuals with a genetically confirmed inherited nephropathy and a previously performed kidney biopsy. A systematic pathological secondary review of the 23 biopsies was carried out (genetic diagnosis unknown at secondary review). The findings of the biopsies were compared with the molecular genetic results. 9 proband and 9 control biopsies were additionally evaluated through LC-MS. Laser capture microdissection was used to extract glomeruli from the tissue samples, which were then further analyzed on alterations in protein expression secondary to the respective disease-causing variants. Results In the cohort, disease-causing variants were identified in the following genes: COL4A3 (n = 3), COL4A5 (n = 4), WT1 (n = 3), UMOD (n = 3), and each n = 1 for the genes INF2, DAAM2, MUC1, COQ8B, NPHP4, TRIM8, CD2AP, NPHS2, CLCN5, and PAX2. The biopsies showed predominantly segmental glomerulosclerosis and parenchymal scarring, as well as podocyte damage. Four individuals with the histological diagnosis of Alport syndrome were genetically confirmed as having X-chromosomal (n = 2; including one female carrier) and autosomal-recessive (n = 2) Alport syndrome. Proteomics showed heterogeneous results. Proband samples carried variants in COL4A3 (n = 3), COL4A5 (n = 3), ADCK4, NPHP4, and WT1 (the last three each n = 1). COL4A3 was detected in 6/9 of control samples and in 0/9 of proband samples; COL4A5 was detected in 5/9 of control samples and in 0/9 of proband samples. ADCK4, NPHP4, and WT1 could not be detected in this analysis, neither in control, nor in proband samples. Conclusion In this study, molecular genetic diagnostics allowed a more precise disease assignment and thus provided information on therapy, prognosis, recurrence in the transplant, possible extrarenal phenotypes, and inheritance. Histological findings can indicate an inherited disease and help to trigger genetic testing (e.g., Alport syndrome). However, genetic diagnostics can also classify cases for which there are no typical morphological criteria described or if severe scarring impairs morphological diagnosis. Numerous cases of a respective monogenic disease would have to be analyzed in order to establish common histopathological criteria, if present. This is a challenge due to the rapid discovery of new disease-associated genes and the rarity of the respective diseases. LC-MS-based proteomics from kidney biopsy samples showed to be of limited value in further characterizing changes associated with specific variants. Unlike the genome, which is consistent due to the stability of DNA, the proteome is influenced by various effects: Different stages of fibrosis depending on the time of biopsy and other factors like coexistent disease lead to varying protein intensities even in two separate samples that present identical genetic variants. The detected protein intensity patterns could not be sufficiently correlated with the genetic findings. Despite the detection of certain proteins of interest like type IV collagens, their intensity variation due to advanced tissue damage did not allow reliable conclusions on the underlying cause. Alternatively, molecular methods such as MALDI imaging could further visualize these changes.

#5091 RITUXIMAB IN MANAGEMENT OF RELAPSING AND STEROID DEPENDANT C1Q NEPHROPATHY: A TALE OF THREE PATIENTS

Abstract Background and Aims C1q nephropathy is an immune glomerular disease in which dominant C1q electron-dense deposits are identified in the mesangium.It commonly presents with nephrotic syndrome, while nephritic syndrome or isolated haematuria are less common. Biopsy findings vary, from no glomerular lesion identified as in minimal change disease (MCD) to focal segmental glomerulosclerosis (FSGS) and immune-mediated proliferative glomerulonephritis. Steroids are the mainstay and other agents have been tried. Rituximab is an anti-CD 20 human/mouse chimeric monoclonal antibody and one of the drugs used in managing C1q nephropathy. We present 3 cases of biopsy-proven C1q nephropathy that presented with nephrotic syndrome. They responded initially to steroids and achieved remission after treatment with rituximab. Method Case Scenarios: Case (1): A 30-year-old man had been diagnosed with steroid sensitive nephrotic syndrome since he was 18 months. Renal biopsy confirmed the diagnosis of C1q nephropathy, more in the spectrum of MCD. He was managed with steroids, and rituximab in 2011 and achieved remission for the last 7 years after 5 doses. His renal function had always remained normal. He presented to our department in 2020 with another relapse and heavy proteinuria (urine protein creatinine ratio (UPCR) was 1300 mg/mmol) but unchanged renal function. Repeat kidney biopsy showed C1q nephropathy in the spectrum of FSGS. He showed good response to oral steroids. On relapse while weaning steroids, Rituximab was considered. He had 2 doses of rituximab of 1 gram 2 weeks apart in July 2021. He achieved full remission over the last 2 years. Case (2): A 77-year-old female presented in 2020 with nephrotic syndrome (UPCR of 660 mg/mmol) and acute kidney injury (AKI) (creatinine 400 μmol/l). Her kidney biopsy showed C1q nephropathy with FSGS features. She was started on haemodialysis due continuous kidney function deterioration. She recovered on steroid therapy to normal kidney function and negative proteinuria, but she relapsed with weaning steroids. So steroid dose was increased and tacrolimus was added. Her renal function remained intact. Following that she had another flare in May 2021 with mild kidney impairment and worse proteinuria (UPCR 500 mg/mmol) while she was on small dose steroid and tacrolimus. She was then started on rituximab. After 2 doses 1 gm 2 weeks apart she achieved remission and her kidney function normalised. She received 2 more doses of 1 gram rituximab 6 months apart with excellent response. She has been in complete remission since. Case (3): A 28-year-old male presented to our department in July 2020 with nephrotic syndrome (urine PCR >900 mg/mmol) and preserved renal function. His kidney biopsy was initially reported as MCD and he was managed with oral steroids. He showed a good response with complete resolution of his proteinuria 3 weeks later and remained in remission for 2 years. However, in August 2022- he suffered a second severe relapse (UPCR 4000 mg/mmol) with preserved renal function. His kidney biopsy was therefore rereviewed and immunofluorescence was added which revealed C1q nephropathy. He had another course of steroids and was initiated on rituximab infusions. He showed full remission after 2 doses (1 gram IV 2 weeks apart) and is on ongoing 6 monthly infusions. Results Rituximab was effective in inducing remission in our patients with nephrotic syndrome due to C1q nephropathy. They were all steroid sensitive. It was effective in both steroid-sensitive and steroid-dependent cases. The first and second cases had biopsy findings in the spectrum of FSGS while the third case histological picture in the spectrum of MCD. They all achieved full resolution of their proteinuria and preserved their renal function finally. Conclusion Rituximab was effective in inducing remission in both steroid-responsive and steroid dependant relapsed patients with C1q nephropathy, despite differences in biopsy results. Kidney function was preserved. More solidified data, including multi-centre randomized controlled trials, are needed to establish clear guidelines for the position of rituximab in the management of the disease and the proper dose to use.

Urgent intraoperative cytological diagnosis of spherical mass lesions in the lungs

Differential diagnosis of pulmonary mass lesions is one of the most difficult tasks not only in pulmonology but also in phthisiology, because clinical manifestations, data from visual and laboratory examinations are undifferentiated in the early stages. In the case of an unclear diagnosis, morphological verification of the process played a crucial role. Urgent intraoperative examination is the most difficult option for morphologic verification of lung lesions, which requires a quick, detailed, and accurate answer.The aim of this study was to evaluate the clinical significance and efficacy of urgent intraoperative cytologic examination in the differential diagnosis between granulomatous (tuberculosis, sarcoidosis), tumor and tumor-like lesions of the lung.Methods. The results of urgent intraoperative cytologic examination of 173 tissue specimens from lung masses were retrospectively analyzed. Cytologic specimens were stained by the May – Grunwald – Giemse and Ziehl – Neelsen methods and then visualized on a Zeiss Lab A1 microscope (Carl Zeiss, Germany). The obtained data are compared with the results of histological examination. To evaluate the effectiveness of intraoperative cytologic examination, the accuracy, sensitivity, and specificity were calculated.Results. Analysis of the results of urgent cytological examinations (n = 173) shows that granulomatosis (tuberculosis/sarcoidosis) was established in 64.7% of cases, malignancy – in 31 cases (cancer – 9.2%, carcinoid tumor – 2.9%, malignant neoplasm of unclear etiology – 4%, suspected malignant lesion – 1.7%); benign process – in 9.2% of cases (hamartoma + chondroma – 5.2%, chronic inflammation – 4%). 1.2% of the cases had no diagnostic material. When comparing the obtained results, there was a discrepancy between the histological picture (2.9% of cases) and the primary clinical diagnosis (5.7% of cases). Sensitivity, specificity, and accuracy of cytologic examination of intraoperative material amounted to 95.9, 71, and 98%, respectively.Conclusion. The high sensitivity and accuracy (> 90%) of urgent cytologic diagnosis of pathologic processes in the lung under intraoperative conditions were demonstrated by the correct assessment of morphologic signs of a given lesion and by their comparison with the clinical picture and the results of additional examinations. Analysis of cytological specimens showed that urgent cytological examination significantly complements the morphological picture of lung lesions and can be considered as the first stage of phenotypic diagnosis.

MICROSCOPIC COLITIS: CONSIDERATIONS FOR GASTROENTEROLOGISTS, ENDOSCOPISTS, AND PATHOLOGISTS.

•Diagnosis of microscopic colitis necessitates effective communication among gastroenterologists, endoscopists, and pathologists. •The gastroenterologist should refer every patient with chronic watery diarrhea to perform a colonoscopy in spite of the benign course of the disease and the absence of alarm symptoms. •The endoscopist should take 2 or 3 biopsy samples of the colonic mucosa from the right and left colon, put in separate recipients, despite that the mucosa looked macroscopically normal. •The pathologist should be encouraged to use objective histological criteria to make the diagnosis. Microscopic colitis is a chronic inflammatory bowel disease characterized by non-bloody diarrhea that can range from mild to severe. It is difficult to attribute up to 10-20% of chronic diarrhea to microscopic colitis. The three determinants factors of the diagnosis are characteristic clinical symptoms, normal endoscopic picture of the colon, and pathognomonic histological picture. This manuscript aimed to update considerations and recommendations for professionals involved (gastroenterologist, endoscopists and pathologist) in the diagnosis of MC. In addition, a short recommendation about treatment.

Comparison of osseointegration properties of individual and standard sized implants

According to clinical and radiological studies,the presented samples of calcium-phosphate ceramicimplants fully perform the osteoconductive function.However, in the case of their dense contact with theedges of the bone defect (experimental group), the primary inflammatory-resorptive stage of reparative osteogenesis turned out to be more intense and prolongedin time with pronounced phenomena of osteoresorptionof the mother bone and volumetric periosteal reactionas a compensatory mechanism. At the same time, osteoid formation is formed around the implant, while thecontrol implants are partially resorbed and replaced byosteoid tissue. As a result, macromorphologically, experimental implants in compact bone are visualized upto the 42nd day, and in cancellous bone - up to the 30thday, while the control implants are covered with boneregenerate already on the 14th day, which in the lattercase indicates the presence of osseointegration processes. The histological picture in the case of experimentalimplants confirms the prolongation of the inflammatory-resorptive stage with the formation of cartilage-boneregenerate around them, i.e. the dense placement of theimplants causes biomechanical pressure on the walls ofthe bone defect with the development of a reaction inthem, primarily to a foreign body.The study of the effect on reparative osteogenesis of the osseointegration properties of the developednew individual and standard-sized bioactive ceramicimplants based on clinical-radiological, macromorphological and histomorphological justification is relevant,as it will make it possible to evaluate their advantagesin terms of consolidation of complex defective fractures of tubular bones and reduce the frequency of theircomplications in animals. Key words: rabbits, bioceramics, reparative osteogenesis, bone defects.

Checkpoint Inhibitor-Induced Colitis: An Update.

Immunotherapy with immune checkpoint inhibitors (ICIs) nowadays has indications for several solid tumors. The current targets for ICIs are CTLA-4, PD-1, and PD-L1 receptors. Despite the clinical advantages derived from ICIs, a variety of side effects are linked to overstimulation of the immune system. Among these, ICI-related colitis is one of the most common, with a disabling impact on the patient. Diarrhea, abdominal pain, abdominal distension, cramping, and hematochezia are the most common ICI enterocolitis presenting symptoms. The most frequently used grading system for assessment of the severity of ICI enterocolitis is called the Common Terminology Criteria for Adverse Events (CTCAE) grading. With regard to the histological picture, there is no specific feature; however, microscopic damage can be classified into five types: (1) acute active colitis, (2) chronic active colitis, (3) microscopic colitis-like, (4) graft-versus-host disease-like, and (5) other types. Supportive therapy (oral hydration, a bland diet without lactose or caffeine, and anti-diarrheal agents) is indicated in mild colitis. Symptomatic treatment alone or with loperamide, a low-fiber diet, and spasmolytics are recommended for low-grade diarrhea. In more severe cases, corticosteroid treatment is mandatory. In refractory cases, off-label use of biological therapies (infliximab or vedolizumab) was proposed.

P366 FULMINANT MYOCARDITIS WITH SPONTANEOUS RESOLUTION AFTER COVID 19 AND ALLERGIC EPISODE: MIS–A OR ALLERGIC MYOCARDITIS?

Abstract Clinical case 23–year–old male. No medical history Not vaccinated for Sars–Cov2; Recent Sars–Cov2 infection (negative antigenic swab on 03/01/22); Pharyngodynia treated with ibuprofen + ciprofloxacin and amoxicillin ac clavulanic acid(suspended for purpuric lesions on hands) After 5 days from onset of symptoms, access to PS for loss of consciousness. Laboratory: ph 7.4; Lat 3.4 EKG: sinus tachycardia HR 126 bpm ECHOCARDIOGRAM: Non–dilated left ventricle, marked reduction in FE (15%) spontaneous echocontrast in ventricular cavity chest TC: hypodense tissue in anterior mediastinum; adenopathy in peribronchial site, distended gallbladder transfer to Vanvitelli Cardiac ICU Amine support with augmented DBT for hypotension and tachycardia LAB: Tni 2193; Nt proBNP 27796; PCR 26; PCT 4; crea 1,4, Lat 1 CATH DX + EMB after 24 hours EBM: …Mixed cellularity endomyocarditis, predominantly lymphocytic, presence of eosinophils… enrollment in the MYTHS study: placebo group (saline solution) after 10 day MRI:Normal biventricular systolic function. Tissue characterization images consistent with the presence of limited area of active myocardial damage and with nonischemic pattern involving the basal segment of the infero–lateral wall of the left ventricle. Discussion The case has been a source of considerable discussion to establish the etiology of myocarditis. Although with numerous doubts, after careful evaluation of the histologic picture, the case falls under possible MIS–A (MULTISYSTEM INFLAMMATORY SYNDROME in adult) Cardiac manifestations of MIS–A include myocarditis, pericarditis, and arrhythmias, which can rapidly lead to cardiogenic shock.