Histopathological Characteristics Of Patients Research Articles

Nodular Regenerative Hyperplasia: Report of 82 Patients and Systematic Review of Literature.

Data about the clinical significance and outcome of patients with nodular regenerative hyperplasia are limited. The aim of this study was to describe the clinical and histopathological characteristics of patients with nodular regenerative hyperplasia and compare our findings with the literature. From January 2015 to March 2021, patients with a diagnosis of nodular regenerative hyperplasia were included. They were extracted from the database of the pathology department of Cliniques universitaires Saint-Luc. Clinical and histological data were retrospectively recorded and complications of portal hypertension and mortality were analyzed. We also performed a systematic review of the literature. Eighty-two histology-proven nodular regenerative hyperplasia were included. The mean age at diagnosis was 58±14years. At least one clinical sign of portal hypertension was present in 37 patients (45%), and liver tissue sampling was performed for 29 of them for evaluation of portal hypertension. Conversely, nodular regenerative hyperplasia was an incidental discovery in 27 patients (33%), mostly after liver resection for metastasis (n=15) or protocol biopsy in liver-transplanted patients (n=9). The 5-year liver-related mortality was 5%. The 5-year non-liver-related mortality was 20%. Patients diagnosed by clinical suspicion (n=55) were compared to patients diagnosed incidentally (n=27). Patients with an incidental diagnosis had more frequently a condition associated with nodular regenerative hyperplasia than patients diagnosed clinically (93% vs. 66%, p=0.008) and they developed significantly lower liver-related complications (4% vs. 27%, p=0.01). A systematic review allowed us to compare our patients with 10 case series in the literature. The clinical spectrum of patients with nodular regenerative hyperplasia is heterogeneous, including patients with clinical liver manifestations and patients diagnosed incidentally who could remain free of liver-related complications. This suggests that nodular regenerative hyperplasia could be a histological epiphenomenon as well as a clinical entity.

Evaluation of clinical, laboratory, radiographical and histopathological characteristics in patients with spinal tuberculosis in the context of HIV infection: An analysis of 52 patients from a South African tertiary hospital.

South Africa (SA) has the highest prevalence of people with tuberculosis (TB) and HIV coinfection globally. People living with HIV have an increased risk of TB infection, and are more likely to develop extrapulmonary TB. Approximately 10 - 20% of extrapulmonary TB accounts for skeletal TB, with spinal involvement in 50 - 60% of instances. Previous studies have shown highly heterogenic results regarding the effect of HIV status on clinical and laboratory characteristics in patients with spinal TB (STB). To describe the clinical, laboratory, radiographical and histopathological characteristics of patients diagnosed with STB stratified by HIV status. Data from patients who were treated for STB at the Division of Orthopaedic Surgery, Groote Schuur Hospital, SA, between 2013 and 2016 were analysed. We compared clinical, laboratory, radiographical and histopathological parameters of STB patients with HIV infection to those without HIV infection. To assess differences in means between the two groups, an independent samples t-test was used for normally distributed continuous data, and a χ2 test for categorical data. To assess correlations between continuous data groups, the Pearson correlation coefficient was used. We assessed 52 patients with STB (mean (standard deviation (SD) age 38 (15.2) years, range 17 - 80 years), of whom 55.8% were female, and 59.6% HIV infected. Five (9.6%) patients were identified with multidrug-resistant TB of the spine, with four (19.0%) in the HIV-infected cohort and one in the HIV-uninfected cohort (p=0.058). Significantly more STB patients without HIV infection presented with neurogenic symptoms (29%, p=0.029). The mean (SD) overall erythrocyte sedimentation rate was 69.3 (35.9) mm/h, with no significant difference between HIV-infected and HIV-uninfected patients (p=0.086). The rate of vertebral collapse was higher in the HIV-infected cohort (39% v. 67%, p=0.048). HIV-infected patients showed a higher count of involved vertebrae (mean 3.0 v. 3.85; p=0.034). There was no correlation between CD4 count and the number of involved vertebrae. The mean (SD) number of granulomata per low-power field was 10 (12.6), with no difference between the two cohorts. However, we found a positive correlation between granuloma count and CD4 cell count in HIV-infected STB patients (Pearson 0.503, p=0.02), with significantly higher formation of granulomata at a CD4 cell count >400 cells/μL (p=0.045). In our cohort, HIV-infected patients with STB were more likely to present with vertebral collapse, and more vertebrae on average were diseased compared with HIV-uninfected patients with STB. CD4 cell count may affect granuloma formation, and it seems that HIV infection has a negative effect on cellular immunoresponse in STB, which emphasises the need for early antiretroviral therapy initiation.

Clinical and Histopathological Characteristics of Patients With Myocarditis After mRNA COVID-19 Vaccination.

The effects of myocarditis after mRNA COVID-19 vaccination (mCV) on myocardial tissue, and the association between cardiomyocyte injury and clinical presentation, are not fully understood. We retrospectively registered patients clinically diagnosed with myocarditis after the first or second mCV who underwent endomyocardial biopsy or autopsy from 42 participating centers in Japan. We investigated the histological features and their association with clinical presentation based on cardiomyocyte injury. Forty patients who underwent endomyocardial biopsy were included in the study. Of these, 19 (47.5%) showed mild lymphocytic infiltration and interstitial edema without cardiomyocyte injury. The remaining 21 (52.5%) patients showed cardiomyocyte injury accompanied by infiltrating inflammatory cells: 11 with lymphocytic infiltration, 7 with eosinophilic infiltration, and 3 with myocarditis with both lymphocyte and eosinophil infiltration. Compared with patients without cardiomyocyte injury, those with cardiomyocyte injury were clinically characterized by older age, a balanced sex distribution, less frequent chest pain, and a lower left ventricular ejection fraction. Fifteen of 21 (71.4%) patients with cardiomyocyte injury developed fulminant myocarditis, with 13 (86.7%) requiring mechanical circulatory support; in contrast, none of those without cardiomyocyte injury developed fulminant myocarditis (P<0.001). Our histological examination of patients with myocarditis after mCV revealed varying degrees of cardiomyocyte injury, ranging from pronounced to absent, along with various types of myocarditis. Cardiomyocyte injury was strongly associated with the severity of myocarditis.

Clinical, radiological and histopathological features of patients with familial pulmonary fibrosis

BackgroundIn familial pulmonary fibrosis (FPF) at least two biological relatives are affected. Patients with FPF have diverse clinical features.Research questionWe aimed to characterize demographic and clinical features, re-evaluate high-resolution computed tomography (HRCT) scans and histopathology of surgical lung biopsies, assess survival and investigate the suitability of risk prediction models for FPF patients.Study designA retrospective cohort study.MethodsFPF data (n = 68) were collected from the medical records of Oulu University Hospital (OUH) and Oulaskangas District Hospital between 1 Jan 2000 and 11 Jan 2023. The inclusion criterion was pulmonary fibrosis (PF) (ICD 10-code J84.X) and at least one self-reported relative with PF. Clinical information was gathered from hospital medical records. HRCT scans and histology were re-evaluated.ResultsThirty-seven (54.4%) of the patients were men, and 31 (45.6%) were women. The mean ages of the women and men were 68.6 and 61.7 years, respectively (p = 0.003). Thirty-seven (54.4%) patients were nonsmokers. The most common radiological patterns were usual interstitial pneumonia (UIP) (51/75.0%), unclassifiable (8/11.8%) and nonspecific interstitial pneumonia (NSIP) (3/4.4%). Pleuroparenchymal fibroelastosis (PPFE) was observed as a single or combined pattern in 13.2% of the patients. According to the 2022 guidelines for idiopathic pulmonary fibrosis (IPF), the patients were categorized as UIP (31/45.6%), probable UIP (20/29.4%), indeterminate for UIP (7/10.3%) or alternative diagnosis (10/14.7%). The histopathological patterns were UIP (7/41.2%), probable UIP (1/5.9%), indeterminate for UIP (8/47.2%) and alternative diagnosis (1/5.9%). Rare genetic variants were found in 9 patients; these included telomerase reverse transcriptase (TERT, n = 6), telomerase RNA component (TERC, n = 2) and regulator of telomere elongation helicase 1 (RTEL1, n = 1). Half of the patients died (n = 29) or underwent lung transplantation (n = 5), with a median survival of 39.9 months. The risk prediction models composite physiology index (CPI), hazard ratio (HR) 1.07 (95.0% CI 1.04–1.10), and gender-age-physiology index (GAP) stage I predicted survival statistically significantly (p<0.001) compared to combined stages II and III.ConclusionsThis study confirmed the results of earlier studies showing that FPF patients’ radiological and histopathological patterns are diverse. Moreover, radiological and histological features revealed unusual patterns and their combinations.

Management and Incidence of Enterobius vermicularis Infestation in Appendectomy Specimens: A Cross-Sectional Study of 6359 Appendectomies.

Background: The role of Enterobius vermicularis infestation in the context of appendicitis is largely overlooked, but Enterobius vermicularis is considered an unexpected and significant appendicectomy finding. The aim of this study was to investigate the frequency of Enterobius vermicularis findings in appendectomies and to evaluate the clinical and histopathologic features of patients with Enterobius vermicularis-associated acute appendicitis and those with appendiceal Enterobius vermicularis infestation. Methods: The medical records of all children who underwent an appendectomy in two large pediatric centers in Croatia between 1 January 2009 and 1 January 2024 were retrospectively reviewed. Of 6359 appendectomies, 61 (0.96%) children were diagnosed with Enterobius vermicularis on histopathology and included in further analysis. The groups were compared with regard to demographic characteristics, laboratory values, clinical features and histopathological findings. Results: The incidence of enterobiasis fluctuated slightly in the individual study years, but was constant overall. The median age of all patients was 11 years (IQR 8.5, 13), with females predominating (60.7%). Acute appendicitis was observed in 34% of the appendiceal species. The patients with Enterobius vermicularis infestation, without appendicitis, were younger (9 years (IQR 8, 13) vs. 12 years (IQR 10, 15); p = 0.020), had longer duration of symptoms (36 h (IQR, 12, 48) vs. 24 h (IQR, 12, 36); p = 0.034), lower body temperature (37 °C (IQR 36.8, 37.4) vs. 37.6 °C (IQR, 37, 38.6) p = 0.012), lower Appendicitis Inflammation Response (AIR) score (3 (IQR 2, 5) vs. 7 (IQR 5, 9.5) p < 0.001), lower incidence of rebound tenderness (57.1% vs. 20%; p = 0.003) and less frequent vomiting (12.5% vs. 47.6%; p = 0.004) compared to the patients with Enterobius vermicularis-associated acute appendicitis. Acute inflammatory markers in the laboratory showed significantly higher values in the group of patients with acute appendicitis: C-reactive protein (p = 0.009), White blood cells (p = 0.001) and neutrophils (p < 0.001). Eosinophilia was not found in any of the groups, although eosinophil counts were significantly higher in children who had Enterobius vermicularis infestation than in those with Enterobius vermicularis-related appendicitis (2.5% (IQR 0.9, 4.3) vs. 1.8% (IQR 0.7, 2.1); p = 0.040). Conclusions: Pediatric surgeons should consider Enterobius vermicularis infestation as a differential diagnosis when removing a vermiform appendix. Younger age, longer duration of symptoms, lower body temperature, lower AIR score, lower diameter of the appendix and normal laboratory inflammatory markers could predict Enterobius vermicularis infection in children presenting with right iliac fossa pain and avoid unnecessary appendectomy.

#634 Prognosis is still poor in patients with posttransplant C3 glomerulopathy: a multicenter cohort

Abstract Background and Aims Data on patients with posttransplant recurrent or de novo C3 glomerulopathy (C3G) are limited. We therefore aimed to analyze features and outcomes of patients developed posttransplant C3G. Method In this retrospective multicenter study conducted across 3 centers, we collected the data of kidney transplant recipients (KTRs) who were diagnosed with posttransplant recurrent or de novo C3G between 2014-2023 and followed for at least 3 months after the diagnosis. Demographic, clinical, laboratory and histopathological characteristics of patients were retrieved from the databases of participating centers. Primary outcome was defined as death-censored graft loss necessitating dialysis or re-transplantation, and secondary outcome was complete (CR) or partial remission (PR). CR was the recovery of baseline eGFR and proteinuria of &amp;lt;0.5 g/g. PR was ≥50% reduction of proteinuria (and to &amp;lt;3 g/g in patients with nephrotic-range proteinuria at baseline) plus stabilization or improvement in kidney function. Results Eleven patients were identified, and 10 with follow-up data were included. Detailed features of patients were shown in the Table. Five (50%) were male, and mean age at the time of transplantation (KTx) was 33.2 ± 8.5 years. Nine KTRs (90%) were diagnosed with recurrent C3G and the etiology of primary kidney disease was not known in one patient. Majority of KTx were performed from living donors (9.90%). One patient had a history of T-cell mediated rejection before posttransplant C3G, which had showed good response to anti-rejection treatment. Posttransplant C3G was diagnosed after a median of 26 (3-85) months after KTx, and mean age was 36.8 ± 9.1 years. Mean hemoglobin, serum creatinine, serum albumin, and proteinuria at the time of diagnosis were 10.5 ± 1.8 g/dl, 1.9 ± 0.7 mg/dl, 4.1 ± 0.5 g/dl, and 1.1 ± 0.9 g/g, respectively. Monoclonal disorders were excluded by using serum and urine electrophoresis and serum free light chain assays in all KTRs. Serum C3 was low (67.1 ± 29.7 mg/dl, ref: 90-180 mg/dl) in 7 of 8 KTRs with available data (87.5%). Further immunosuppressive treatment was administered in 9 cases. Eculizumab was used in 8, and 1 patient was treated with pulse steroids and therapeutic plasma exchange. Median duration of treatment was 14.5 (3-24.3) months. Four patients (44.4%) who were treated with eculizumab showed CR. After a median of 32 (9.5-82) months, 5 KTRs (50%) experienced graft loss despite eculizumab use in 3 of them. No adverse events attributed to treatment were observed. Conclusion Prognosis is still quite dismal in patients with posttransplant C3G despite the use of eculizumab. Better treatment options are urgently needed.

Clinical Characteristics and Outcomes of TFE3-Rearranged/TFEB-Altered Renal Cell Carcinoma with Systemic Therapies, Including Tyrosine Kinase Inhibitors or Immune Checkpoint Inhibitors: An Observational Study

Purpose: &lt;i&gt;TFE3&lt;/i&gt;-rearranged/&lt;i&gt;TFEB&lt;/i&gt;-altered renal cell carcinoma (RCC) is a rare subtype of RCC. Due to its rarity, there is an unmet medical need for effective therapies in advanced settings. The study aims to investigate the clinical and histopathological characteristics of patients with microphthalmia transcription factor family/ transcription factor E (MiTF/TFE) translocation RCC and the clinical outcomes of systemic therapies, including tyrosine kinase inhibitors (TKIs) or immune checkpoint inhibitors (ICIs).Materials and Methods: This was a single-center, retrospective study. We identified 32 eligible patients among a total of 37 patients diagnosed with MiTF/TFE translocation RCC between January 2004 and September 2021, and the study included 9 patients who were treated with systemic therapies. We collected data on clinical characteristics, targeted sequencing, and clinical outcomes.Results: The median age of the 32 patients was 45.5 years. Histologically, 26 patients (81.3%) had &lt;i&gt;TFE3&lt;/i&gt;-rearranged RCC, and only 1 patient (3.1%) had &lt;i&gt;TFEB&lt;/i&gt;-altered RCC. Curative or cytoreductive nephrectomy was performed in all 27 patients (84.4%), and 4 patients (12.6%) were diagnosed with metastatic disease at the time of the initial diagnosis. Nine patients (28.1%) were treated with systemic therapy with TKIs, 2 (6.3%) of whom received simultaneous TKI and ICI treatment. The response to systemic therapy (TKI or ICI) and duration of response ranged from complete response to progressive disease. Excluding 1 patient who was treated with a TKI in the adjuvant setting, the overall response rate in 8 metastatic patients was 50% and the complete response rate was 37.5%. The median follow-up period was 29 months. The median progressionfree survival was 21 months, median overall survival was not achieved, and 2 deaths occurred.Conclusions: Our findings suggest that TKI for treatment for metastatic &lt;i&gt;TFE3&lt;/i&gt;-rearranged RCC is efficacious, with an overall response rate of 50% and a median progression-free survival of 21 months.

Investigation of Clinical, Laboratory, Imaging Findings and Histopathological Features of Patients wıth Gastric Neuroendocrine Cell Hyperplasia.

Neuroendocrine cell hyperplasia is a non-neoplastic proliferation of enterochromaffin-like cells and is considered a premalignant lesion because of their potential to progress to neuroendocrine tumor. In this study, we aimed to evaluate the demographic and clinical features, laboratory, radiological and endoscopic findings, gastric biopsy histopathological features, follow-up frequency, and histopathological findings of patients diagnosed with gastric neuroendocrine cell hyperplasia as well as to investigate the factors that play a role in the development of neuroendocrine tumors on the basis of neuroendocrine cell hyperplasia. The study has been conducted in 2 centers with 282 patients that were grouped as those with and without neuroendocrine tumor. Individuals with control endoscopy were separated as those with regression of neuroendocrine cell hyperplasia and those without regression, and the determined parameters were evaluated between the groups. The most common histological subtype of neuroendocrine cell hyperplasia was linear+micronodular (50.4%). Neuroendocrine tumor developed in 4.3% (12/282) of the patients with neuroendocrine cell hyperplasia after a mean of 36 months. The presence of polyps as confirmed via endoscopy and dysplasia as confirmed via histopathological examination was significantly higher in favor of the group with neuroendocrine tumor (P = .01). In patients with neuroendocrine cell hyperplasia regressed and patients in whom it did not regress were examined, the rate of asymptomatic patients and increased sedimentation rate were found in favor of the group that did not regress (P = .02 and P = .02), but no difference was found in other parameters. Neuroendocrine tumor development rate was found to be 4.3% in the background of neuroendocrine cell hyperplasia. Two factors predicting progression from neuroendocrine cell hyperplasia to neuroendocrine tumor can be elaborated as the presence of polypoid appearance due to neuroendocrine cell hyperplasia as confirmed via endoscopy and dysplasia as confirmed via histopathological examination.

Increased Diagnostic Accuracy of the Labial Gland Biopsy in Primary Sjögren Syndrome When Multiple Histopathological Features Are Included.

The aim of this study was to evaluate the diagnostic accuracy of the labial salivary gland biopsy based on multiple histopathological features in patients with suspected primary Sjögren syndrome (pSS). Patients from a diagnostic sicca cohort with clinically suspected pSS who underwent a labial gland biopsy were included. Patients were categorized as having pSS or non-Sjögren syndrome sicca (non-SS sicca) based on vignettes scored by an expert panel. Labial gland biopsies were analyzed for the presence of four histopathological features: focus score (FS) ≥1, prelymphoepithelial and lymphoepithelial lesions, immunoglobulin G plasma cell shift, and germinal centers. Sensitivity and specificity of histologic features were calculated, and the optimal cutoff value for the number of histopathological features needed to diagnose pSS was determined with receiver operating curve analysis. A total of 38 patients were categorized as having pSS and 65 as having non-SS sicca. In labial gland biopsies of patients with pSS, the prevalence of FS ≥1 was 82%, followed by 68% for pre-lymphoepithelial and lymphoepithelial lesions, 63% for plasma cell shift, and 24% for germinal centers. Although FS ≥1 showed the highest sensitivity for patients with pSS (82%), specificity was higher for the other three features (98%-100%). The presence of two or more (of four) histopathological features had almost comparable sensitivity to FS alone, but specificity increased with 12% to 100%. For fulfillment of American College of Rheumatology/EULAR criteria, specificity increased from 84% to 95% when an abnormal biopsy was defined by the presence of two or more histopathological features instead of FS ≥1 only. The diagnostic accuracy of the labial gland biopsy increases when other histopathological features besides FS are taken into account, by reducing the number of false-positive biopsies.

Artículo traducido] Impacto de la pandemia COVID-19 en el carcinoma de células escamosas cutáneo: un estudio unicéntrico de los factores epidemiológicos, clínicos e histopatológicos

BackgroundThe COVID-19 pandemic may have adversely affected the early diagnosis of skin cancer. ObjectiveTo compare epidemiological, clinical and histopathological characteristics in patients undergoing cutaneous squamous cell carcinoma (SCC) surgery before and after the beginning of the pandemic. Material & methodsWe conducted a cross-sectional study including two case series: (1) patients operated on for SCC in the year after the first state of alarm in Spain (15 March 2020), and (2) patients with SCC operated on in the previous year. Epidemiological, clinical and histopathological variables, tumour stage and risk grade were collected. Results248 patients were included (127 undergoing surgery before the pandemic and 121 after the pandemic). After the beginning of the pandemic, the percentage of high-risk SCC significantly increased from 35.3% to 46.2% (p=0.011). However, no significant differences were found in thickness, perineural invasion or metastases. ConclusionsAlthough there has not been a significant reduction in the number of SCC operated on after the pandemic, there has been a significant increase in high-risk SCC. All this could lead to an increase in skin cancer mortality in the future.

Reconstructive techniques for lower eyelid and canthal defects after tumor resection.

This prospective study aims to evaluate the demographic and histopathological characteristics of patients who underwent resection of malignant skin tumors of the lower eyelid. It also seeks to assess the size of the defect and outline the management strategies for reconstructing anterior and posterior lamellae. The study enrolled 87 patients treated between January 1, 2018, and December 31, 2022. The article outlines areconstructive strategy based on the defect characteristics. The most prevalent type of tumor was basal cell carcinoma (86%), followed by squamous cell carcinoma (8%), malignant melanoma (5%), and Merkel cell carcinoma (1%). There was aslight male preponderance (52%). No significant difference was found in the incidence of lower eyelid malignant tumor between the sex subgroups (p=0.97). The mean age of the patients was 73.52 years (SD=10.582; range 37-92 years). No statistically significant difference in laterality (p=0.108) was observed. Alarger tumor size was significantly associated with ahigher tumor grade (p=0.008; r=0.926). Asignificant correlation was identified between the tumor location and the size of the excision (p<0.001). Furthermore, asignificant correlation was identified between the histopathological types of tumors and the excision area (p=0.016). Reconstruction of the anterior lamella in small- and medium-sized defects was achieved by using local randomized flaps (61%), primary closure (29%), and skin grafts (10%). For large-sized defects, the anterior lamella was reconstructed by flap (88%) or skin graft (22%). Altogether, posterior lamella was replaced in 25 cases (29%) of all defects using nasal chondromucosa (40%), conchal cartilage (28%), buccal mucosa (8%), periosteal flap (12%), Hewes flap (8%) and Hughes flap (4%). Advanced techniques are necessary when reconstructing alarger lower lid area. In such cases, various subunits must be reconstructed separately to achieve optimal functional and aesthetic outcomes. However, the choice of reconstructive technique mainly depends on the extent of the lid resection (Fig. 9, Ref. 44). Text in PDF www.elis.sk Keywords: defects, eyelid, malignant neoplasms, reconstructive surgical procedures, resection.

Correlations Between Preoperative Indicators and Postoperative Histopathological Outcomes in Prostate Cancer Patients

Objective: Prostate cancer continues to pose a significant health challenge, with diverse prognoses influenced by preoperative and postoperative assessments. This study aims to elucidate the correlation between preoperative clinical indicators and postoperative histopathological outcomes to enhance prognostic models. The primary objective of this study is to investigate the predictive value of preoperative factors, such as age, Prostate-Specific Antigen (PSA) level, prostate volume (PV), and tumor volume (TV), on postoperative outcomes, specifically focusing on extracapsular invasion (ECI), seminal vesicle invasion (SVI), and positive surgical margins (PSM). Materials and Methods: We retrospectively analyzed the data of 63 patients with prostate cancer who underwent radical prostatectomy. Preoperative clinical data, including age, PSA level, PV, and TV, were collected. Postoperative histopathological data were gathered for ECI, SVI, and PSM. Statistical analyses, including correlation coefficients and median comparisons, were employed to identify significant predictors of postoperative outcomes. Results: The cohort had a mean age of 64.1 years, with PSA levels ranging from 3.65 to 112 ng/ml. Patients with ECI had a median PSA of 14.9 ng/ml, whereas those without had 8.2 ng/ml (p=0.001). Median PV and TV were significantly higher in patients with ECI (PV: 55 cc, TV: 8.07 cc) than in those without ECI (PV: 49 cc, TV: 4.25 cc, p=0.001). Similar significant differences were noted for SVI and PSM, with higher PSA, PV, and TV values in patients with these features (p≤0.042). Age did not significantly affect the outcomes. Conclusion: Preoperative PSA level, prostate volume, and tumor volume were significant predictors of adverse postoperative histopathological features in patients with prostate cancer. These findings highlight the need for a multifactorial approach in preoperative evaluation and advocate the development of enhanced predictive models for improved clinical decision-making and patient management.

Abstract 15666: Comprehensive Biopsy and Clinical Features In Coronavirus Disease 2019 Vaccine-Associated Myocarditis - From Nationwide Survey COMBAT Study in Japan -

Introduction: Few studies have reported on myocardial tissue findings of coronavirus disease 2019 (COVID-19) vaccine-associated myocarditis (CVAM). This study aimed to investigate the clinical and histopathological features of patients with CVAM. Methods: This is a multicenter and retrospective cohort study (COMBAT study) of patients who were clinically diagnosed with CVAM and underwent endomyocardial biopsy in 42 participating centers in Japan. The inclusion criteria were the following; 1. Occurrence of clinical symptoms within 30 days after getting the first or second dose of the COVID-19 vaccine between February 2021 and March 2022. 2. The exclusion of acute coronary syndrome using coronary angiography. 3. Abnormality of laboratory tests. Fulminant myocarditis (FM) was defined as catecholamine or mechanical support use during hospitalization. Results: A total of 44 patients were included. Fifteen of 44 (34%) patients were clinically diagnosed with FM. FM patients were older and showed fewer ratio of males than non-FM. Also, FM patients showed significantly a longer duration from vaccination to the occurrence of symptoms and less frequency of chest pain than non-FM (Table).In hematoxylin-eosin (HE) stained samples, 28 of 44 (64%) patients were histologically diagnosed with acute myocarditis. Among them, 24 patients were diagnosed with lymphocytic myocarditis (LM) and 4 with eosinophilic myocarditis (EM). In HE stained samples, 5 of 24 (21%) LM patients visually showed a high ratio of eosinophils compared to the common type of LM. The 5 LM patients had a significantly larger number of eosinophils using by immunohistochemistry of eosinophilic cationic protein and a higher ratio of eosinophils to CD3 than the common type of LM (Figure). Conclusions: In patients with CVAM, there may be a difference in clinical features between FM and non-FM patients. Also, a relatively larger number of eosinophils in the myocardium could be infiltrated in patients with CVAM.

Emotion recognition in relation to tumor characteristics in patients with low-grade glioma.

Patients with low-grade gliomas (LGG) treated with surgery, generally function well and have a favorable prognosis. However, LGG can affect neurocognitive functioning. To date, little is known about social cognition (SC) in these patients, although impaired SC is related to social-behavioral problems and poor societal participation. Frontal brain areas are important for SC and LGG frequently have a frontal location. Therefore, the aim of the present study was to investigate whether emotion recognition, a key component of SC, was impaired, and related to general cognition, tumor location, laterality, tumor volume, and histopathological characteristics in patients with LGG, postsurgery, and before start of adjuvant therapy. A total of 121 patients with LGG were matched with 169 healthy controls (HC). Tumor location [including (frontal) subregions; insula, anterior cingulate cortex, lateral prefrontal cortex (LPFC), orbitofrontal-ventromedial PFC] and tumor volume were determined on MRI scans. Emotion recognition was measured with the Ekman 60 faces test of the Facial Expressions of Emotion-Stimuli and Tests (FEEST). Patients with LGG performed significantly lower on the FEEST than HC, with 33.1% showing impairment compared to norm data. Emotion recognition was not significantly correlated to frontal tumor location, laterality, and histopathological characteristics, and significantly but weakly with general cognition and tumor volume. Emotion recognition is impaired in patients with LGG but not (strongly) related to specific tumor characteristics or general cognition. Hence, measuring SC with individual neuropsychological assessment of these patients is crucial, irrespective of tumor characteristics, to inform clinicians about possible impairments, and consequently offer appropriate care.

Clinicopathological Profile of Dermatitis Herpetiformis Patients in Saudi Arabia.

Objectives The aim of this study was to describe the clinical, serological, and histopathological features of patients with dermatitis herpetiformis (DH) in Saudi Arabia. Methods We retrospectively reviewed the medical charts of all patients diagnosed with DH in the dermatology departments of National Guard Health Affairs (NGHA) hospitals in five different cities, from 2016 to 2022. We included patients who had been diagnosed by a dermatologist and had a combination of typical DH skin lesions, positive immunoglobulin A (IgA) on direct immunofluorescence (DIF), and/or positive tissue transglutaminase (tTG) IgA. Results A total of 11 patients were included. Their average age was 43.6 ± 12.5 years, and the ratio of females: males was 2.7: 1. Among the eight skin biopsies performed, IgA was detected on DIF in five patients. Seven out of nine patients (77.8%) had positive tTG IgA. Nine patients were managed with dapsone and a gluten-free diet (GFD); they had excellent responses within months. Conclusion The profiles of Saudi patients with DH were similar to those of Caucasian patients, but DH appears to be less common in Saudi Arabia. The high positive rates of tTG IgA make it an important tool for diagnosis in unclear cases. Dermatitis herpetiformis is likely associated with underlying gluten-sensitive enteropathy in Saudi patients.

Dupilumab-Associated Lymphoid Reactions in Patients With Atopic Dermatitis

Since the increased use of dupilumab for atopic dermatitis (AD) in daily practice, several cases have been reported on the development of cutaneous T-cell lymphomas (CTCL) and lymphoid infiltrates. To provide insight in the clinical and histopathologic features of patients with AD clinically suspected for CTCL during dupilumab treatment. This retrospective observational case series included adult (≥18 years) patients with AD treated with dupilumab between October 2017 and July 2022 at the University Medical Center Utrecht in the Netherlands. Relevant patient, disease, and treatment characteristics were evaluated. Skin biopsies before, during, and after treatment were collected and reassessed. Fourteen patients (54.5% male) with a median (IQR) age of 56 (36-66) years suspected for CTCL with deterioration of symptoms during dupilumab treatment were included. Of 14 patients, 3 were retrospectively diagnosed with preexistent mycosis fungoides (MF). Eleven patients with AD were eventually diagnosed with a lymphoid reaction (LR). These patients showed MF-like symptoms; however, histopathologic findings were different, and included sprinkled distribution of small hyperchromatic lymphocytes in the upper epidermal section, a dysregulated CD4:CD8 ratio, and CD30 overexpression, without loss of CD2/CD3/CD5. The median time to clinical worsening was 4.0 months (IQR, 1.4-10.0). Posttreatment biopsies showed complete clearance of the LR in all patients. This study found that dupilumab treatment can cause a reversible and benign LR, which mimics a CTCL, though has distinctive histopathologic features.

Impact of COVID-19 Pandemic on Cutaneous Squamous Cell Carcinoma: A Single-Centre Study of Epidemiologic, Clinic and Histopathological Factors

BackgroundThe COVID-19 pandemic may have adversely affected the early diagnosis of skin cancer. ObjectiveTo compare epidemiological, clinical and histopathological characteristics in patients undergoing cutaneous squamous cell carcinoma (SCC) surgery before and after the beginning of the pandemic. Material & methodsWe conducted a cross-sectional study including two case series: (1) patients operated on for SCC in the year after the first state of alarm in Spain (15 March 2020), and (2) patients with SCC operated on in the previous year. Epidemiological, clinical and histopathological variables, tumour stage and risk grade were collected. Results248 patients were included (127 undergoing surgery before the pandemic and 121 after the pandemic). After the beginning of the pandemic, the percentage of high-risk SCC significantly increased from 35.3% to 46.2% (p=0.011). However, no significant differences were found in thickness, perineural invasion or metastases. ConclusionsAlthough there has not been a significant reduction in the number of SCC operated on after the pandemic, there has been a significant increase in high-risk SCC. All this could lead to an increase in skin cancer mortality in the future.

MAFLD and NAFLD as underlying etiologies of hepatopathies

Introduction: Non-alcoholic fatty liver disease (NAFLD) is closely related to metabolic risk factors and is a highly prevalent disorder. NAFLD concept has evolved into metabolic-associated fatty liver disease (MAFLD), reflecting a more inclusive diagnostic approach related to those metabolic factors. Although the rate of liver transplantation (LT) for NAFLD/MAFLD patients has risen in Western countries, in our midst, it remains a relatively uncommon indication for LT recipients. Simultaneously, cryptogenic cirrhosis (CC) continues to be a prevalent cause of LT in our patient population. Material and methods: A cross-sectional observational study was conducted on 387 adult patients who underwent their first LT for liver cirrhosis (LC) at a Brazilian referral center between 2008 and 2018. The prevalence of clinical and histopathological characteristics of patients with CC and LC of known etiology were analyzed and compared. The diagnosis of MAFLD was reassessed according to established criteria for both groups. Results: Seventy-nine (20.4%) patients had CC, and 308 (79.6%) had LC with a defined etiology; among these, only one had NAFLD. Type 2 diabetes mellitus (T2DM) presented independent association with the CC group (32.5% vs. 21.3%; odds ratio 2.45, 95% confidence interval 1.34-4.46; p=0.003). The other characteristics showed no association with the groups. Fifteen patients (22.7%) previously diagnosed with CC were found to have MAFLD, along with 37 (15.6%), who underwent LT for cirrhosis with a defined etiology. Conclusion: NAFLD/MAFLD were frequent in patients undergoing LT in both groups, and T2DM was more prevalent in the CC group. These findings suggest that NAFLD is probably an unidentified etiology in patients with CC.

Clinical, Laboratory, and Histopathological Evaluation of 493 Patients Who Underwent Endoscopic Biopsy with a Presumptive Diagnosis of Celiac Disease: Association with Autoimmune Diseases.

Celiac disease is an immunological reaction provoked by gluten digestion in genetically vulnerable individuals in response to unknown environmental factors. It affects 0.7% of the world's population and occurs at a rate of 1% in most nations. We aimed to assess the clinical, laboratory, and histopathological characteristics of patients with a presumable diagnosis of celiac disease and to investigate the coexistence of autoimmune disorders. In this retrospective study, data were gathered from the medical files of a total of 493 individuals with a preliminary diagnosis of celiac disease who underwent endoscopic biopsies. Analysis was carried out for clinical, biochemical, and histological results, as well as the presence of autoimmune disease. Per the results of serological tests used in the diagnosis of celiac disease in this series, gliadin IgA and IgG positivities were found in 33.7% (n = 54/160) and 39.4% (n = 69/175) of patients; endomysium IgA and IgG positivities were detected in 37% (n = 88/238) and 18% (n = 30/167) of patients, while tissue transglutaminase IgA and IgG positivities were detected in 47.3% (n = 115/243) and 16.3% (n = 15/92) of patients, respectively. The incidence of patients with a CD3 level of ≥30% was 69.1% in 152 patients whose CD3 levels were tested. The general public and healthcare professionals need to be more aware of the prevalence and many signs of celiac disease. There is still a need to conduct the necessary research in this area. By boosting awareness, early diagnosis, and diet, it will be possible to prevent symptoms and negative consequences.

Adverse Reactions Associated with Dermal Fillers in the Oral and Maxillofacial Region: A Venezuelan Experience.

Dermal facial fillers are increasingly popular. Published reports on the clinical and histopathologic characteristics related to adverse reactions to dermal fillers in the facial region have been relatively well documented. This study adds to the literature on adverse reactions to injected filler in the oral and maxillofacial region in a South American population. A retrospective, descriptive cross-sectional study (2019-2020) was performed. The study population was a dermatology service in Venezuela. Clinical and histopathologic features of patients with adverse effects were documented. A total of 35 cases of adverse reactions associated with cosmetic filler procedures were diagnosed during the analyzed period; of these, six cases (17.1%) involved the oral and maxillofacial region. All cases occurred in women. The mean age at diagnosis was 59.3 years (58-73). In three cases, dermal fillers were used in different locations on the face, while three involved the lips. Five patients exhibited adverse reactions to lip filler. All six cases were histopathologically diagnosed as foreign body reactions to injected material. Four and two cases revealed microscopic features compatible with hyaluronic acid and polymethylmethacrylate, respectively. Reflecting the dramatic increase in cosmetic procedures with soft tissue fillers, this study contributed by reporting six cases of foreign body reaction involving the oral and maxillofacial region, confirmed with biopsy and histopathology.