Histopathology Of Biopsy Research Articles

Multiple core histopathologies for discriminative diagnosis of phyllodes pathology in breast

Background: Historical patient’s records were analyzed. Patients diagnosed with phyllodes tumors of the breast who received preoperative core needle biopsy and undergone breast surgery at a tertiary cancer centre in Patna, Bihar, India from January 2020 to December 2020. The resulting data allowed us to compare the accordance between core needle biopsy and final histopathology of phyllodes tumor of the breast patients and evaluate the accuracy of core needle biopsy in preoperative diagnosis. Methods: This is a retrospective study evaluated the case records of one hundred twenty (n=120) patients for core needle biopsy findings and subsequent histopathology reports post-surgery. Sensitivity and significance of core needle biopsy was determined for phyllodes tumor of the breast. Results: A total of one hundred twenty (n=120) patients’ data were analyzed. There were ninety (n=90) fibroadenoma and thirty (n=30) phyllodes tumor patients. Sensitivity of core needle biopsy for benign tumor was 64.2%, borderline 40% and a malignant phyllodes tumor was 100% respectively. Conclusions: Core needle biopsy provides a pathological basis for pre-operative diagnosis of phyllodes tumor, but it has a low accuracy and offers limited guidance for surgical decisions, if used alone. An integrated assessment using needle biopsies in combination with clinical data and imaging features is suggested as a reliable strategy to aid phyllodes tumor diagnosis and subsequent treatment.

Spatial Omics Imaging of Fresh-Frozen Tissue and Routine FFPE Histopathology of a Single Cancer Needle Core Biopsy: A Freezing Device and Multimodal Workflow

The complex molecular alterations that underlie cancer pathophysiology are studied in depth with omics methods using bulk tissue extracts. For spatially resolved tissue diagnostics using needle biopsy cores, however, histopathological analysis using stained FFPE tissue and the immunohistochemistry (IHC) of a few marker proteins is currently the main clinical focus. Today, spatial omics imaging using MSI or IRI is an emerging diagnostic technology for the identification and classification of various cancer types. However, to conserve tissue-specific metabolomic states, fast, reliable, and precise methods for the preparation of fresh-frozen (FF) tissue sections are crucial. Such methods are often incompatible with clinical practice, since spatial metabolomics and the routine histopathology of needle biopsies currently require two biopsies for FF and FFPE sampling, respectively. Therefore, we developed a device and corresponding laboratory and computational workflows for the multimodal spatial omics analysis of fresh-frozen, longitudinally sectioned needle biopsies to accompany standard FFPE histopathology of the same biopsy core. As a proof-of-concept, we analyzed surgical human liver cancer specimens using IRI and MSI with precise co-registration and, following FFPE processing, by sequential clinical pathology analysis of the same biopsy core. This workflow allowed for a spatial comparison between different spectral profiles and alterations in tissue histology, as well as a direct comparison for histological diagnosis without the need for an extra biopsy.

Evaluation of Antithymocyte Globulin Efficacy in Reversing Refractory Graft Rejection Using Retrospective Event-Based Sequential Graft Biopsy Analysis in Living Related Donor Renal Transplant.

The main risk factor for poor graft outcomes is refractory acute rejection and its consequences. In this study, we compared the efficacy of antithymocyte globulins versus other antirejection strategies in reversing refractory acute graft rejection after living donor renal transplant. We retrospectively reviewed the records of 745 patients who received living-donor kidney transplants and experienced acute rejection episodes at Mansoura Urology and Nephrology Center in Egypt over the past 20 years. Based on the type of antirejection medication that they received, we divided patients into 2 groups, with 80 patients in the antithymocyte globulin group and 665 patients who had other antirejection strategies. By using event-based sequential graft biopsy histopathology analysis, we compared the efficacy of antithymocyte globulins in reversing refractory rejection in terms of graft and patient complications and survival. Patient survival was comparable in both groups; however, graft survival was better in the antithymocyte globulin group than in the other group; in addition, event-based sequential graft biopsies revealed a lower incidence of acute and chronic rejection episodes after treatment of severe acute rejection in the antithymocyte globulin group compared with the other group. Incidence of posttreatment complications, particularly infection and malignancy, was comparable in both groups. Our retrospective analysis of event-based sequential graft biopsy allowed us to track graft rejection resolution or worsening. Antithymocyte globulins are highly effective in reversing acute graft rejection when compared with other approaches, with no increased risk of infection or malignancy.

An Inflammatory Myopathy in the Dutch Kooiker Dog.

The Dutch Kooiker dog (het Nederlandse Kooikerhondje) is one of nine Dutch dog breeds. As of 1960, a number of heritable diseases have been noted in this breed. One is an inflammatory myopathy that emerged in 1972, with numbers of affected dogs gradually increasing during the last few decades. The objective of this paper is to describe clinical signs, laboratory results, electromyography and histopathology of the muscle biopsies of the affected dogs. Method: Both retrospectively as well as prospectively affected Kooiker dogs were identified and categorized using a Tiered level of Confidence. Results: In total, 160 Kooiker dogs-40 Tier I, 33 Tier II and 87 Tier III-were included. Clinical signs were (1) locomotory problems, such as inability to walk long distances, difficulty getting up, stiff gait, walking on eggshells; (2) dysphagia signs such as drooling, difficulty eating and/or drinking; or (3) combinations of locomotory and dysphagia signs. CK activities were elevated in all except for one dog. Histopathology revealed a predominant lymphohistiocytic myositis with a usually low and variable number of eosinophils, neutrophils and plasma cells. It is concluded that, within this breed, a most likely heritable inflammatory myopathy occurs. Further studies are needed to classify this inflammatory myopathy, discuss its treatment, and unravel the genetic cause of this disease to eradicate it from this population.

Case Report: Tracheal infiltration with wheezing revealing Hodgkin's disease

Hodgkin's disease with an initial tracheobronchial involvement is extremely rare. The symptoms might be misleading, resulting in a diagnosis delay. We report the case of a 38-year-old woman with a one-month history of wheezing and a non-productive cough. The physical examination revealed a good general state of health, bilateral diffuse wheezing and supra-clavicular lymphadenopathy. The adenopathy biopsy's histopathology revealed Hodgkin's disease. The whole body FDG-PET scan was an important tool to assess the diagnosis as well as for the staging. The patient was treated with chemotherapy. Another unusual aspect is the tracheobronchial metastasis confirmed by a bronchial biopsy. Thus, our patient was put on a second-line chemotherapy. She died one year after the initial diagnosis. To conclude, it is a rare case of an Hodgkin lymphoma with a tracheobronchial relapse. It should be considered in the differential diagnosis of a tracheal tumor.

Mycosis fungoides and Sézary syndrome: clinical presentation, diagnosis, staging, and therapeutic management.

Mycosis fungoides (MF) and Sézary syndrome (SS) are cutaneous T-cell lymphomas. MF is the most common cutaneous lymphoma, and it is classified into classic Alibert-Bazin MF, folliculotropic MF, pagetoid reticulosis, and granulomatous slack skin, each with characteristic clinical presentation, histopathological findings, and distinct clinical behaviors. SS is an aggressive leukemic variant of cutaneous lymphoma, and it is characterized by erythroderma, lymphadenopathy, and peripheral blood involvement by malignant cells. There is a wide range of dermatological manifestations of MF/SS, and prompt recognition is essential for early diagnosis. Skin biopsy for histopathology and immunohistochemical analysis is imperative to confirm the diagnosis of MF/SS. Histopathology may also provide information that may influence prognosis and treatment. Staging follows the TNMB system. Besides advanced stage, other factors associated with poorer prognosis are advanced age, male gender, folliculotropism in histopathology of patients with infiltrated plaques and tumors in the head and neck region, large cell transformation, and elevated lactate dehydrogenase. Treatment is divided into skin-directed therapies (topical treatments, phototherapy, radiotherapy), and systemic therapies (biological response modifiers, targeted therapies, chemotherapy). Allogeneic bone marrow transplantation and extracorporeal photopheresis are other treatment modalities used in selected cases. This review discusses the main clinical characteristics, the histopathological/immunohistochemical findings, the staging system, and the therapeutic management of MF/SS.

Epidemiological, Clinical, and Histopathological Characteristics of Patients with Sporotrichoid Lymphocutaneous Infection in Southern Thailand: A 10-Year Retrospective Study.

Sporotrichoid lymphocutaneous infection is caused by a variety of pathogens. However, in most cases, the causative pathogen cannot be identified on the basis of clinical and histopathological features. We examined the clinical manifestations, histopathologic findings, causative pathogens, treatment, and prognostic factors of sporotrichoid lymphocutaneous infection, specifically in the context of Thailand. The electronic medical records of patients with sporotrichoid lymphocutaneous infection who visited Songklanagarind Hospital from January 2000 to December 2010 were reviewed. A total of 53 patients were included; 41 (77.4%) were female, 12 (22.6%) were male, and the mean (SD) age was 52.9 (± 15.9) years. Nodules, plaques, and papules were the most commonly observed morphologies. Upper extremities were the most commonly infected sites. Mammal-caused injuries were associated with fungal infection but not at a statistically significant level. The most common histopathologic finding was suppurative granuloma. The identified causative pathogens were mainly dematiaceous fungus and occasionally nontuberculous Mycobacterium. Itraconazole was the medication of choice for empiric and specific treatment of the patients with confirmed fungal infection. Dematiaceous fungi were the most common identified pathogens causing sporotrichoid lymphocutaneous infection in southern Thailand. Empirical itraconazole is useful, especially in patients who report contact injury caused by pets at the primary lesion site. Skin biopsy for tissue histopathology and culture is essential.

Alopecia in Patients with Collagen VI-Related Myopathies: A Novel/Unrecognized Scalp Phenotype.

Collagen VI-related myopathies are characterized by severe muscle involvement and skin involvement (keratosis pilaris and impaired healing with the development of abnormal scars, especially keloids). Scalp involvement and hair loss have not been reported among cutaneous changes associated with collagen VI mutations. The aim of this study is to describe the clinical, trichoscopic, and histological findings of the scalp changes in patients affected by COL VI mutations and to estimate their prevalence. Patients with Ullrich congenital muscular dystrophy were enrolled and underwent clinical and trichoscopic examinations and a scalp biopsy for histopathology. Five patients were enrolled, and all complained of hair loss and scalp itching. One patient showed yellow interfollicular scales with erythema and dilated, branched vessels, and the histological findings were suggestive of scalp psoriasis. Two patients presented with scarring alopecia patches on the vertex area, and they were histologically diagnosed with folliculitis decalvans. The last two patients presented with scaling and hair thinning, but they were both diagnosed with folliculitis and perifolliculitis. Ten more patients answered to a "scalp involvement questionnaire", and six of them confirmed to have or have had scalp disorders and/or itching. Scalp involvement can be associated with COL VI mutations and should be investigated.

MP44-05 SERUM PSA TRENDS AND PROSTATE CANCER DETECTION ON FOLLOW-UP IN MEN WITH A PRIOR NEGATIVE BIOPSY: A COHORT STUDY

You have accessJournal of UrologyCME1 Apr 2023MP44-05 SERUM PSA TRENDS AND PROSTATE CANCER DETECTION ON FOLLOW-UP IN MEN WITH A PRIOR NEGATIVE BIOPSY: A COHORT STUDY Ankush Modi, Prabhjot Singh, Amlesh Seth, and Rajeev Kumar Ankush ModiAnkush Modi More articles by this author , Prabhjot SinghPrabhjot Singh More articles by this author , Amlesh SethAmlesh Seth More articles by this author , and Rajeev KumarRajeev Kumar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Serum PSA above the normal range is the most common trigger for a prostate biopsy. However, the range of normal PSA is poorly defined in many populations. Men with ‘elevated’ PSA may not harbour cancer and it is unclear if such men with a prior negative biopsy should be biopsied again. We conducted a cohort study to assess PSA trends and cancer detection rates in such men with a prior negative biopsy. METHODS: In an IRB approved ambispective study, men who underwent prostate biopsy between January 2016 and December 2021 for PSA>4ng/mL were identified. Among them, those whose biopsy was negative for malignancy were contacted either telephonically or reviewed in person and the most recent PSA and histopathology of any repeat prostate biopsy was determined. These were evaluated to assess the PSA trend, re-biopsy and cancer detection rate. RESULTS: During the study period, a total of 1260 prostate biopsies were performed out of which 444 were negative for malignancy and 241 patients fulfilled the inclusion criteria (Figure 1). Their median pre-biopsy PSA was 16.5 ng/mL (interquartile range [IQR] 7.99-79.39) and median follow up PSA was 9.81 (IQR 7.14-15.6). Follow up PSA had decreased in 177 patients (73.4%), was static in 48 patients (19.9%) and increased in only 16 patients (6.6%). Repeat biopsy was performed in 20 patients, of whom 7 had cancer (35%) with overall positivity rate of 2.9% among those included (Figure 2). Although the positivity rate was higher in men with increased PSA, it was not statistically different from those with lower or similar PSA. No factors could be identified to predict a positive repeat biopsy. CONCLUSIONS: PSA, the sole trigger for a prostate biopsy, declined in nearly three quarters of men with a negative first biopsy and less than 3% men were detected to have cancer on a repeat biopsy. This information could help appropriately counsel patients and allay anxiety after a negative biopsy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e612 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ankush Modi More articles by this author Prabhjot Singh More articles by this author Amlesh Seth More articles by this author Rajeev Kumar More articles by this author Expand All Advertisement PDF downloadLoading ...

Corrigendum: Accuracy of Optical Coherence Tomography for Subtyping Basal Cell Carcinoma: Using Histopathology of Biopsy and Entire Lesion as Reference Standard.

Abstract is missing (Corrigendum)
 This Corrigendum relates to the following article: https://doi.org/10.2340/actadv.v102.4383

The risk of prostate cancer on incidental finding of an avid prostate uptake on 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography for non-prostate cancer-related pathology: A single centre retrospective study

ObjectiveTo review the risk of prostate cancer (PCa) in men with incidentally reported increased intraprostatic uptake at 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) ordered at Department of Urology, The Wesley Hospital, Brisbane, QLD, Australia for non-PCa related pathology. MethodsRetrospective analysis of consecutive men between August 2014 and August 2019 presenting to a single institution for 18F-FDG PET/CT for non-prostate related conditions was conducted. Men were classified as benign, indeterminate, or malignant depending of the results of prostate-specific antigen (PSA), PSA velocity, biopsy histopathology, and three-Tesla (3 T) multiparametric MRI (mpMRI) Prostate Imaging Reporting and Data System score, or gallium-68-prostate-specific membrane antigen (68Ga-PSMA) PET/CT results. ResultsThree percent (273/9122) of men demonstrated 18F-FDG avidity within the prostate. Eighty-five percent (231/273) were further investigated, including with PSA tests (227/231, 98.3%), 3 T mpMRI (68/231, 29.4%), 68Ga-PSMA PET/CT (33/231, 14.3%), and prostate biopsy (57/231, 24.7%). Results were considered benign in 130/231 (56.3%), indeterminate in 31/231 (13.4%), and malignant in 70/231 (30.3%). PCa was identified in 51/57 (89.5%) of the men who proceeded to biopsy, including 26/27 (96.3%) men with Prostate Imaging Reporting and Data System scores 4–5 mpMRI and six men with a positive 68Ga-PSMA PET/CT. The most common Gleason score on biopsy was greater than or equal to 4+5 (14/51, 27.5%). 68Ga-PSMA PET/CT was concordant with the 18F-FDG findings in 26/33 (78.8%). All 13 men with a positive concordant 18F-FDG, 3 T mpMRI, and 68Ga-PSMA PET/CT had PCa on biopsy. There was no statistically significant difference in the 18F-FDG maximum standardized uptake value between the benign or malignant groups (5.7 vs. 6.1; p=0.580). ConclusionIn this study, after an incidental finding of an avid intraprostatic lesion on 18F-FDG PET/CT, 70 of the 231 cases (30.3%; 0.8% of the entire cohort) had results consistent with PCa, most commonly as Gleason score greater than or equal to 4+5 disease. Unless there is limited life expectancy due to competing medical co-morbidity, men with an incidental finding of intraprostatic uptake on 18F-FDG should be further investigated using principles of PCa detection.

Accuracy of Optical Coherence Tomography for Subtyping Basal Cell Carcinoma: Using Histopathology of Biopsy and Entire Lesion as Reference Standard

Abstract is missing (Short communication)

Blind Spot in the Radar of MEST-C Score: Type and Severity of Tubulointerstitial Nephritis in IgA Nephropathy.

The updated version of predictive classification for immunoglobulin A nephropathy (IgAN) prognosis "The Oxford Classification" identifies five histopathological features including mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T) and crescents (C), the MEST-C. However, few studies suggest that tubulointerstitial inflammation, which is not included in the MEST-C, is also linked to disease progression and is, consequently, a neglected determinant of prognosis among others. Therefore, there is a need to evaluate this histopathological parameter in patients with IgA nephropathy. This cross-sectional descriptive study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan. Data of histopathological and immunofluorescence proven renal biopsies (300) of IgA nephropathy patients from January 2016 through May 2022 were extracted using a convenient sampling technique. Biopsies were histologically reviewed for type and severity of tubulointerstitial inflammation, in addition to the MEST-C score. Renal biopsies of patients who had a history of transplant, autolyzed tissue, no glomeruli on histological examination, and/or a tubular atrophy/interstitial fibrosis score of 2 (T2) in MEST-C scoring were excluded. Data were analyzed using SPSS 20. An association between the variables was analyzed using the chi-square and Fischer exact tests. A p value less than 0.05 was considered statistically significant. A total of 247/300 biopsies were eligible for inclusion. The mean age at the time of biopsy was 31.90 ± 12.48 with 63.6% in the age group between 21 and 40 years, and 69.6% were male. Tubulointerstitial inflammation was observed in 90.2% cases with 49.4% showing moderate while 4.5% showing severe degree of inflammation. A strong association of both the type and severity of tubulointerstitial inflammation was found with M, E, T, and C scores (p value < 0.05). The high-frequency and strong statistical association of tubulointerstitial inflammation with the M, E, T, and C scores in our study elucidate its prognostic role in the progression and management of IgA nephropathy.

A comprehensive comparison between mpMRI of the prostate, MR-US fusion biopsy and whole mount histopathology.

To compare multiparametric magnetic resonance imaging (mpMRI) findings, US-MR fusion prostate biopsy results and whole-mount thin-section histopathology after radical prostatectomy. Overall 259 patients,who had undergone mpMRI with lesions reported as PI-RADS 3-5, underwent a MR-US fusion biopsy between 2018 and 2020.Overall 186 biopsies yielded prostate cancer and 104 patients subsequently underwent endoscopic extraperitoneal radical prostatectomy. Histopathology of biopsies was compared to the final histopathology in whole mount thin sections after radical prostatectomy by means of descriptive statistics, and further, the lesions from mpMRT were compared to whole mount histology. Prostate cancer was diagnosed in 186 (71.8%) of 259 patients (median age 69.2 y, range 42-82 y, median PSA 7.8ng/ml, range 2.1-31.3ng/ml). Of those, 95 (51,1%) underwent radical endoscopic prostatectomy, and 80 (43%) chose radiotherapy or active surveillance. In 52/95 (54,7%) with RPE additional lesions were found in the final histological whole mount sections not described at mpMRI. 22/95 (23,2%) of RPE patients had ≥ 1 additional Gleason score ≥ 7 lesions, 23 /259 (8,4%) of biopsies, respectively. The Gleason score after surgery was upgraded in 37/95 (38,9%) and downgraded in 18/95 (18,9%) patients. If we compare all 259 performed biopsies with the final histological whole mount sections which showed additional lesions with Gleason ≥ 7 (23,2%), it can be assumed that up to 10% ofclinical significant carcinomas are missed during primary assessment via mpMRI. The majority of additional findings after RP were intermediate/high risk tumors. Upgrades from low-risk to intermediate or high-risk occurred.

Bronchoscopic manifestations and interventional treatment of pulmonary mucormycosis

Objective: To analyze the bronchoscopic manifestations and interventional treatment of pulmonary mucormycosis. Methods: Clinical data of patients with pulmonary mucormycosis undergoing bronchoscopy and interventional therapy in 4 tertiary general hospitals in China from May 2006 to May 2022 were retrospectively analyzed and the literature on the subject were reviewed. Results: The data of 10 patients with pathologically diagnosed pulmonary mucormycosis undergoing bronchoscopy and interventional therapy were collected, including 8 males and 2 females. The patients' age ranged from 21 to 72 (44±15) years. The underlying diseases included 6 cases of diabetes ketoacidosis, 3 cases of leukemia, 1 case after operation of lung cancer. Bronchoscopy showed that white viscous necrotic matters grew along the airway and blocked the airway in 9 cases, accompanied by airway bleeding in 3 cases, bloody secretion blocked the airway in 1 case, and bronchopulmonary cavity fistula in 2 cases. The biopsy histopathology of white necrotic matters showed that many mucor filaments were tangled together which were named mucormycelium. Among the 10 patients, 9 were treated with systemic drugs, including intravenous application of amphotericin B deoxycholate in 5 cases, intravenous application of amphotericin B liposome in 4 cases, oral posaconazole in 6 cases and intravenous injection in 1 case. Local drug therapy included aerosol inhalation of amphotericin B deoxycholate in 8 cases and local perfusion under bronchoscope in 5 cases. Bronchoscopic interventional therapy was used to remove mucormycelium in the bronchus, including cryotherapy in 8 cases, biopsy forceps in 7 cases, snare treatment in 2 cases and foreign body forceps in 2 cases. All 10 patients were clinical cured and with no death. Conclusions: Pulmonary mucormycosis is more common in immunocompromised hosts. Bronchoscopy often showed mucormycelium blocking the airway. Systemic and local drug therapy combined with bronchoscopic interventional therapy can achieve good clinical efficacy.

Systemic mastocytosis mimicking blastic plasmacytoid dendritic cell neoplasm: a case report

BackgroundSystemic mastocytosis (SM), a rare myeloid neoplasm, is defined as a clonal and neoplastic proliferation of mast cells in at least one extracutaneous organ(s). The pathologic diagnosis and treatment of SM are challenging.Case presentationWe presented a 44-year-old male patient who had endured abdomen discomfort for 4 years and diarrhea for 5 months. Colonoscopy and PET/CT found a protuberant lesion in the cecum with adjacent lymphadenopathy. Histopathology of the cecum biopsy showed diffuse infiltration of medium-sized round/oval cells in lamina propria with immunohistochemical expressions of CD45, CD117, CD25, CD68, CD123, CD56, CD4, and CD35, mimicking blastic plasmacytoid dendritic cell neoplasm. Sanger sequencing revealed missense mutation (D816V) in the exon 17 of KIT gene. Serum tryptase level was 38.56 ng/ml. No abnormality was found in skin examination and bone marrow biopsy. No primitive cells were observed in bone marrow smear and peripheral blood smear. The diagnosis of aggressive SM with intestinal tract involvement was established. The patient received avapritinib treatment at an initial dosage of 200 mg once daily and exhibited dramatic clinical improvement but memory impairment within 1 month. No recurrence was observed in 1-year follow-up at the adjusted avapritinib dose (75 mg once daily).ConclusionsSM is very rare and should be considered in patients with long-term diarrhea symptoms and hematopoietic/lymphoid-appearing tumors. KIT D816V mutation contributes to the differentiation of CD123, CD4, and CD56 immunoreactive SM from blastic plasmacytoid dendritic cell neoplasm. The rare side-effect of memory impairment in this case helps to accumulate the experience of avapritinib in treating KIT D816V-mutant SM.

Primary Isolated Breast Lymphoma Presenting as Primary Breast Cancer with 18F-FDG PET/CT.

A 40-year-old woman with a palpable mass lesion in her right breast suggested as breast cancer was admitted to 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) unit for the metabolic characterization of the lesion and for the staging of the disease. The patient had no fever and no evidence of weight loss or night sweats. 18F-FDG PET/CT revealed an isolated solid mass lesion with increased 18F-FDG uptake in the upper outer quadrant of the right breast and increased 18F-FDG uptake in the lymph nodes of the right axilla suspected as primary breast cancer and its local lymph node metastasis. There was no other pathological 18F-FDG uptake in the whole body. Excisional biopsy histopathology revealed diffuse large B-cell non-Hodgkin lymphoma.

Psorergatic mange in two ring‐tailed lemurs (Lemur catta)

AbstractTwo 6‐year‐old ring‐tailed lemurs (Lemur catta), housed in two different zoological institutions, were evaluated for nonpruritic nodules located on the eyelids, lips and chest. The first lemur was anaesthetized for diagnostic investigations. Although pan‐herpes polymerase chain reaction was positive and bacterial culture yielded Staphylococcus warneri, histopathology of skin biopsies revealed a severe chronic dermatitis and folliculitis with intralesional arthropods, identified as Psorobia sp. on skin scrapings. The second lemur was also diagnosed a psorergatic mange. After several treatment failures, weekly topical applications of amitraz were performed and a minimum of five applications were necessary to notice the complete resolution of the lesions. Amitraz toxicity was not observed, despite the first lemur being pregnant at the time of treatment. This is the first report of psorergatic mange in a prosimian species and the first reported use of amitraz as a successful treatment for this disease.

Comparative Evaluation of RLEP-PCR and Conventional Laboratory Methods for Confirmation of Clinically Diagnosed Early-stage Leprosy in Eastern India

Introduction: Leprosy is an infectious disease caused by Mycobacterium leprae (M. leprae). Diagnosis of leprosy is confirmed based on cardinal signs and symptoms along with supportive laboratory investigations. Early diagnosis and treatment of new cases are essential to prevent disease burden and spread in community. Aim: To evaluate the efficacy of currently available laboratory tests like M.leprae-specific repetitive element Polymerase Chain Reaction (RLEP-PCR) and conventional methods like, Slit Skin Smears (SSS), Histopathology (HP) and Fite-Faraco (FF) staining for detection of M. leprae in clinically diagnosed cases of early- stage leprosy. Materials and Methods: A cross-sectional study of 82 newly diagnosed cases of leprosy was carried out in S.C.B Medical College, a tertiary care hospital of Odisha, India from September 2018 to August 2020. For every case, skin tissue was punched out to get biopsy for HP and FF staining and incised for SSS. At least two SSS slides were prepared per case. One SSS slide was stained by modified Ziehl-Neelsen (ZN) staining to demonstrate Acid Fast Bacilli (AFB). The other SSS slide was air dried and the dried material was scraped off to perform PCR. Data were analysed by Statistics software IBM Statistical Package for the Social Sciences (SPSS), version 24.0. Association between categorical variables was studied by using Chi-square test. Comparison of mean±SD and median (IQR) were done by using independent sample‘t’ test. Agreement on different types of laboratory methods was done by using Kappa test. Results: Among 82 cases, 68.3% were RLEP-PCR positive, 56% had relevant chronic granulomatous features histopathologically, 39% were FF stain positive, and only 29% were ZN stain positive. Improvement in case detection of 39%, 29.3%, and 12.2% by PCR over SSS, FF Stain and HP respectively proved superiority of PCR over other procedures. Conclusion: PCR was most sensitive to detect leprosy both in pauci and multibacillary groups, thus considered as investigation of choice for diagnosis of early-stage leprosy.

Immunoexpression of CD1a and Histopathology in Lesional and Non Lesional Skin in Psoriasis: A Cross-sectional Study

Introduction: Psoriasis is a long-lasting autoimmune disease mediated by T-lymphocytes and dendritic cells. Langerhans cells are a unique population of dendritic cells found in the epidermis, where they can be identified by Cluster of Differentiation 1a (CD1a) positivity. They play an important role in the pathogenesis of psoriasis. Aim: To evaluate the utility of immunoexpression of CD1a in the early diagnosis of psoriasis and to study the histopathology of skin biopsies from clinically diagnosed cases of psoriasis. Materials and Methods: A cross-sectional study was conducted from September 2017 to August 2019 at Gandhi Hospital, Secunderabad, Telangana, India. Skin biopsies were taken from 50 patients with psoriasis from the Outpatient Department (OPD). Histopathological features in early psoriasis were studied, and CD1a immunoexpression in lesional, perilesional, and distant skin was analysed. The data were analysed using Student’s t-test with the Statistical Package for the Social Sciences (SPSS) software. Results: Half of the cases were found in two age groups: 51-60 years (15 patients, 30%) and 11-20 years (10 patients, 20%). The majority of the cases were males (36 patients, 72%). Most of the biopsies were taken from the lower limb (24 patients, 48%), followed by the back (13 patients, 26%). In this study, the average number of CD1a positive Langerhans cells was highest (54.92±5.26) in perilesional skin compared to lesional skin (30±3.96), which was statistically significant (p-value=0.04). Conclusion: Based on the observations in this study, a strong positive reaction of CD1a in perilesional skin can be used to diagnose psoriasis in the early clinical stages, before full-blown clinical psoriatic plaques have appeared. Early diagnosis may prompt physicians to initiate treatment early