Histopathological Findings Research Articles

Clinical and pathologic characteristics of inflamed juvenile conjunctival nevus and its treatment with immunosuppressant eye drops.

To clarify the clinical and pathologic findings of 7 patients with inflamed juvenile conjunctival nevus (IJCN) treated with tacrolimus. Retrospective study. The medical records of 7 male patients diagnosed with IJCN between February 2007 and October 2022 at the Kansai Medical University Hospital and Ideta Eye Hospital were retrospectively reviewed. The patients' mean age was 11.3 (8-20) years, and the average follow-up period was 18 months. The patients underwent anterior segment optical coherence tomography (AS-OCT) and anterior segment optical coherence tomography angiography (AS-OCTA). All the patients were treated with steroids or immunosuppressant eye drops, or both. Histopathologic examinations were performed on specimens resected from 2 patients. The clinical characteristics of IJCN were as follows: (1) presence of cysts within a pigmented conjunctival mass, (2) tumor accompanied by feeder vessels, and (3) predominantly found in boys with allergic diseases. AS-OCT and AS-OCTA revealed the presence of a cystic structure with poor vascular signals within it and numerous vessels distributed on the sclera underlying the lesion. Immunosuppressant eye drops relieved the congestion, diminished the inflow vessels, and induced shrinkage of the cysts in all the patients. Histopathologic examinations revealed infiltration of inflammatory cells such as lymphocytes and macrophages and low proliferative activity of melanocytes with no division pattern. This study clarified the clinical and histologic characteristics of IJCN. Noninvasive AS-OCT and AS-OCTA might be useful for diagnosing IJCN. The histopathologic findings of this study indicate that immunosuppressive and antiallergic agents can effectively bring about disease remission.

Clinico-histopathological characteristics and management outcome of rare chronic infective granulomatous diseases: A case series study

Granulomatous skin diseases are common cutaneous dermatoses commonly encountered by practicing dermatologist. Granulomatous skin lesions are distinctive pattern of chronic inflammatory response of skin due to reaction against various organic and inorganic antigens. Granulomas are characterized by focal collection of epithelioid cells or histiocytes, admixed with variable number of leucocytes (especially mononuclear cells) and multinucleated giant cells. Granulomatous reaction is a type IV hypersensitivity reaction evoked by poorly soluble reactive substances. Incidence and prevalence of different types of granulomatous dermatitis depend on geographic location. Granulomatous skin lesions are common in the eastern parts of India. Many granulomatous skin lesions have identical histomorphology and conversely a single pathology can produce varied histological features. Some rare suppurative chronic granulomatous skin diseases include Botryomycosis, Actinomycosis, Rhinosporoidosis, Nocardiosis, and Cutaneous Tuberculosis. To describe clinical, histopathological features and treatment outcome of rare chronic infective granulomatous diseases. In this observational case series study, we retrospectively analysed six biopsy proven cases of rare chronic infective granulomatous diseases presented to our department (OPD) of Dermatology, Venereology and Leprosy (DVL) over a period of six months between June 2023 to November 2023 at Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India. The patient’s full clinical history, morphology of lesions, histopathological findings and treatment outcome were analysed. Along with histopathology, other necessary laboratory investigations were performed if required. A total of six patients were involved in the study, of whom four were males and two were females. The male to female ratio was 2:1, with a slight male majority. The most common age group was 31-40 years for both males and females. Painful raised lesion for long duration was the predominant complaint among those patients. Out of these six rare chronic granulomatous diseases, bacterial infections were common than fungal infection. All the cases showed clinical improvement after one month of starting treatment.: Most of the patients had a chronic history with improper treatment. So, it is imperative that the clinical diagnosis has to be confirmed with histopathology for the definitive diagnosis and appropriate treatment of these rare chronic infective granulomatous diseases. All these rare cases showed excellent progress after starting the right treatment.

Quercetin and its potential therapeutic effects on aluminum phosphide-induced cardiotoxicity in rats: Role of NOX4, FOXO1, ERK1/2, and NF-κB.

Acute Aluminum phosphide (AlP) poisoning poses a serious global issue, yet the exact mechanisms behind AlP-induced cardiotoxicity are still not well understood. Moreover, there is no specific antidote available for AlP toxicity. Nevertheless, Quercetin (QE) has emerged as a promising therapeutic candidate in various contexts. Accordingly, our study aimed to evaluate the QE potential therapeutic effects against AlP-induced cardiotoxicity and the mechanisms underlying such effects. Rats were assigned into four groups: Group I (control group), Group II (vehicle (corn oil) group), Group III (AlP group) received a single dose of AlP (10 mg/kg body weight) dissolved in corn oil by oral gavage, and Group IV (AlP + QE group) received a single dose of QE (400 mg/kg body weight) dissolved in saline, one hour after AlP administration. AlP-induced cardiotoxicity was evidenced by the increase in cardiac troponin I (cTnI) as well as the hemodynamic, ECG, and histopathological abnormalities. The AlP group denoted a decrease of the antioxidant enzymes; catalase and SOD and an increase of the lipid peroxidation marker; MDA. This was associated with a notable increase in inflammatory cytokines (TNFα, IL-6, and IL1β), in addition to a significant upregulation of the expression of NOX4, FOXO1, ERK1/2, and NF-κB. Moreover, Caspase3, and BAX showed strong immunopositive expression, while Bcl-2 showed mild immunoexpression. On the other hand, treatment with QE showed an improvement in the cardiotoxic effects of AlP, as indicated by significant enhancements in biomarkers, functional assessments, and histopathological findings. These results suggest that QE may be a promising candidate for treating AlP-induced cardiotoxicity, attributed to its antioxidant, anti-inflammatory, and anti-apoptotic properties, particularly emphasizing the roles of NOX4, FOXO1, ERK1/2, and NF-κB.

Inhalation Exposure to Cross-linked Polyacrylic Acid Induces Pulmonary Disorders.

Organic polymers, widely used in food, daily necessities, and medicines, include cross-linked polyacrylic acid (CL-PAA), which has been reported to induce severe lung disease. While previous studies mainly used intratracheal instillation, our research focused on inhalation exposure to corroborate these findings. We conducted 5-day (short-term) and 13-week (subchronic) inhalation exposure studies with CL-PAA. In the short-term study, male F344 rats inhaled CL-PAA at 0.2, 2.0, or 20mg/m³ for 6hours/day over 5 days. Rats were dissected 3 days and 1 month post-exposure. In the subchronic study, rats inhaled CL-PAA at 0.2 or 2.0mg/m³ for 6hours/day, 5 days/week for 13 weeks, with dissections from 3 days to 6 months post-exposure. To investigate the mechanism of pulmonary disorders, an additional short-term study with 20mg/m³ CL-PAA included intraperitoneal injections of the antioxidant N-acetylcysteine (NAC) (200mg/kg) with dissection the day after exposure. Short-term exposure led to concentration-dependent increases in neutrophil influx, cytokine-induced neutrophil chemoattractant (CINC), total protein, lactate dehydrogenase (LDH) in bronchoalveolar lavage fluid (BALF), and heme oxygenase-1 (HO-1) in lung tissue. Histopathology showed concentration-dependent neutrophil infiltration. Subchronic exposure caused persistent increases in BALF total protein and lung HO-1, with ongoing neutrophil infiltration and fibrosis. NAC administration reduced neutrophils, total protein, LDH, and CINC in BALF, and HO-1 in lung tissue, improving histopathological findings. Inhalation of CL-PAA caused concentration-dependent lung inflammation and persistent fibrosis. The no observed adverse effect level (NOAEL) for chronic pulmonary disorders was 0.2mg/m³. Oxidative stress linked to CL-PAA-induced inflammation was mitigated by NAC administration.

ZNAČAJ DIGITALNE STEREOTAKSIJSKE BIOPSIJE U KORELACIJI SA PATOHISTOLOŠKIM POSTOPERATIVNIM NALAZIMA

Aim : This research was conducted with the aim of analyzing the accuracy and diagnostic value of digital stereotactic breast biopsy compared to the postoperative histopathological findings. Methods : A retrospective-prospective study was carried out over a period of 10 months, involving 30 female patients who underwent stereotactic breast biopsy. Data were collected on BI-RADS status, histopathological findings after stereotactic breast biopsy and after surgical excision, basic demographic and relevant medical history data. The patients were divided according to the degree of malignancy into three groups: patients with benign, patients with suspicious and patients with malignant pathohistological findings. The BIS and RIS systems were used for data collection, and the data were statistically analyzed using STATISTICA for Windows. Results : All patients had a radiological finding of BI-RADS 3 or higher. Histopathological results after stereotactic biopsy showed benign findings in 17 patients (B1 and B2), borderline malignant changes were present in 4 patients (B3), one patient had a lesion suspicious for malignancy (B4), and 8 had confirmed malignant lesions (B5). Out of the total 30 patients, 13 underwent surgical treatment. Postoperative histopathological findings in 4 patients showed benign changes, 6 patients had an invasive form of carcinoma, including 5 with invasive NST breast carcinoma and one characterized as invasive ductal breast carcinoma, while three patients had Ductal Carcinoma In Situ (DCIS). A correlation test was performed between the estimated degree of malignancy from the pathohistological findings after stereotaxic biopsy and after surgical operation. Spearman's ρ test showed a significant correlation between the two methods (p < 0.001). Conclusion : The results of histopathological analysis of samples obtained through the stereotactic biopsy method largely correlate with the postoperative histopathological diagnosis in patients who underwent surgical treatment. Keywords : digital stereotactic breast biopsy, PHD findings, BI-RADS, NST, Ductal Carcinoma In Situ.

HPB SO73 - Histopathological Patterns in Emergency and Elective Cholecystectomy

Abstract Background Laparoscopic cholecystectomy (LC) is one of the most frequently performed general surgical procedures. In the United Kingdom, gallbladder specimens are routinely submitted for histopathological analysis to detect occult pathologies, such as carcinoma in situ and early-stage carcinomas. This study aims to assess the results of routine histopathological examination of LC specimens. Method A prospectively collected database of all LCs and laparoscopic common bile duct exploration (LCBDE) performed between August 2022 and June 2024 was analysed. The database was populated from a single benign biliary center by two specialized biliary surgeons. Electronic case notes were analysed for the demographics, indication(s), operative findings and the histopathological results. All gallbladder specimens were sent for histopathology analysis, irrespective of their gross appearance. Results Of the 201 eligible patients, 164 patients had histopathology results available. Median age was 56 years (IQR 41-66) and 100 (61%) were female. 72 (43.9%) were emergency cases. 48 (29.3%) had cholecystectomy, 70 (42.7%) also had intraoperative cholangiogram and 46 (28%) had LCBDE. Conclusion Chronic calculus cholecystitis was the most frequent histopathological finding, followed by acute on chronic cholecystitis and gangrenous acute cholecystitis. Dysplasia was identified in 1.8% of patients, warranting multidisciplinary team discussion. This study underscores the significance of routine histopathological examination after cholecystectomy, as early incidental detection of dysplasia and carcinoma can modify postoperative management and improve patient outcomes.

Heterotopic Ossification with Intrathyroidal Extramedullary Hematopoiesis in Multifocal Papillary Thyroid Carcinoma: Histopathological Findings and Literature Review.

In recent decades, there has been an increase in the identification of thyroid nodules, both benign and malignant, due to the rise in imaging studies and complementary tests. Among thyroid gland tumors, papillary thyroid carcinoma (PTC) stands out as the most prevalent. Degenerative changes, mainly in the form of nodular goiter, have been recorded, occasionally including areas of calcification and, more rarely, ossification; although the latter seldom progresses to calcinosis. Ectopic bone formation, known as osseous metaplasia, is a rare phenomenon in the thyroid gland, even more so when associated with extramedullary hematopoiesis (EMH), characterized by the presence of hematopoietic elements outside the bone marrow. We present the first documented instance in our country of a patient diagnosed with malignant thyroid nodule, specifically PTC, exhibiting areas of heterotopic ossification with EMH on histopathological examination of the surgical specimen. A possible relationship between heterotopic ossification, EMH, and PTC is suggested. Various growth factors such as bone morphogenetic proteins (BMPs), specific BMP subtypes, and associated receptors could play a crucial role in initiating and developing ectopic bone formation in the context of PTC. However, further research is needed to fully elucidate its clinical significance and impact on the therapeutic management of these patients.

A novel chronic obstructive pulmonary disease mouse model induced by intubation-mediated intratracheal co-administration of porcine pancreatic elastase and lipopolysaccharide.

Chronic obstructive pulmonary disease (COPD) is a significant respiratory disorder in humans characterized by persistent airway constriction or obstruction due to chronic bronchitis and pulmonary emphysema. Various methods of inducing COPD in mouse models are frequently used in COPD research; however, these cannot completely reproduce histopathologic lesions. This study aimed to establish a new COPD mouse model that reproduces histopathological lesions closely resembling clinical COPD within a shorter induction time. The new strategy involved the co-administration of porcine pancreatic elastase (PPE) and lipopolysaccharide (LPS), with PPE intended to induce pulmonary emphysema and LPS intended to induce chronic bronchitis. Male C57BL/6J mice were administered PPE (8 U/kg) on days 0 and 3 and LPS (400µg/kg) on days 6, 9, 12, and 15. Each administration was performed using a noninvasive intubation-mediated intratracheal instillation method with a laryngoscope. Postmortem examination on day 22 revealed that pulmonary emphysema and chronic bronchitis were simultaneously induced in 90.91% of the lung lobes. Molecular studies revealed higher messenger ribonucleic acid (mRNA) expression levels of interleukin-6(IL-6) and matrix metalloproteinase-12(MMP-12) associated with the pathogenesis of COPD. A new method was developed to establish a COPD mouse model that displays a more severe representation of the histopathological findings of clinical COPD than previous COPD models. It also reduces the time required for model induction. This newly developed COPD mouse model is expected to be a valuable tool for the pathogenesis and therapeutic research on human COPD.

Comprehensive Analysis of Liver Biopsies in a Tertiary Care Hospital: A Retrospective Histopathological and Clinical Correlation Study

Liver biopsy (LB) served as a vital diagnostic tool for cases with notable alterations in liver function tests and for diagnosing a range of liver diseases, including chronic liver disease, cirrhosis, primary biliary cirrhosis, and hepatic neoplasms. Patients presenting with liver pathology often exhibited nonspecific symptoms, such as abdominal discomfort, nausea, vomiting, fever, indigestion, and flatulence. Based on patients' clinical history and radiological findings that suggested liver disease, a liver biopsy was frequently recommended, as it provided definitive diagnostic insights. Histopathological analysis of liver biopsies offered critical information on disease severity, grading, staging of liver tumors, and the presence of any coexisting hepatic conditions.This study retrospectively examined liver biopsies submitted to the Department of Pathology, correlating histopathological findings with clinical and radiological data. Through this integration, the research contributed to improved diagnosis, management, and follow-up of liver disease cases in a tertiary care setting.

TRATAMENTO CIRURGICO DE CERATOCISTOS ODONTOGÊNICOS: RELATO DE CASO CLÍNICO

Introduction: The keratocyst or keratocyst is an odontogenic tumor characterized as a lesion that affects the maxillary and mandibular regions. It is considered a benign lesion, reaching a prevalence of 3% to 11% among all odontogenic cysts, resulting in major bone loss. It can be asymptomatic and is usually diagnosed through routine radiographs or histopathological findings. Objective: To present a clinical case concerning the diagnosis and surgical treatment of an odontogenic keratocyst in the anterior mandibular region. Clinical case: Male, normosystemic, melanodermic patient. An increase in extraoral volume was observed on the right side of the face in the anterior region of the mandible. Panoramic radiography revealed well-defined, unilocular radiolucent images in the areas of the right lower first premolar, left lower third molar and bilateral upper third molars. On intraoral physical examination, bone bulging was observed in the region of the tooth in question. A computerized tomography scan was then requested, in which extensive expansive bone lesions were detected. Marsupialization and local decompression of the two upper lesions and the lower right lesion were performed, detecting the presence of liquid content. Firstly, an incisional biopsy was carried out and a decompression drain was installed in the three lesions. The histopathological report was of an odontogenic keratocyst. The decompression device remained in place for 30 days in the lower right lesion and approximately 15 days in the upper lesions, showing a significant reduction in the lesions. The lower right lesion was then enucleated. The 6-month post-operative image showed bone formation with no signs of recurrence. Conclusion: The proposed treatment proved to be effective in treating odontogenic keratocysts, but follow-up imaging is extremely important in view of the possibility of recurrence.

Frequent Occurrence of High-Risk Basal Cell Carcinoma in Xeroderma Pigmentosum: A Histopathological Insight From an Indian Cohort.

Xeroderma pigmentosum (XP) is a genodermatosis, characterized both by premature aging and significantly increased risk of non-melanoma and melanoma skin cancers at an early age. However, limited literature is available on the common histopathological subtypes of basal cell carcinoma (BCC) in these patients. In this ambispective case series, we recruited patients of XP who had either a currently present skin tumor or previously excised one, provided their histopathological sections were available. Cytogenetic analysis was performed in all the patients. The histopathological findings were recorded by two trained dermatopathologists. Of 22 recruited patients with XP, 12 patients had 41 BCCs, and 23 (56.09%) of them showed a high-risk histopathological subtype. Basosquamous carcinoma (10, 24.39%) was the most frequent high-risk tumor followed by infiltrative variant (7, 17.07%). Mixed-histopathological subtypes were noted in six (14.63%) cases, and all of them had a high-risk component. The low-risk subtypes included nodular (n = 17, 41.46%) and superficial BCC (1, 2.43%). Though a deep dermal involvement was seen in 27 (65.85%) lesions, none showed a perineural invasion or necrosis. Three (7.31%) lesions showed ulceration, while 10 (24.39%) showed presence of pigmentation. A frequent occurrence of high-risk basal cell carcinoma was noted in patients with XP-mandating creation of appropriate treatment and follow-up strategies in these patients.

Use of the immunohistochemical marker HBME-1 to optimize the diagnosis of follicular carcinomas

Background. In clinical practice, there are often patients with a diagnosis of benign follicular adenoma (FA) and follicular tumor with an uncertain malignant potential, whose diagnoses must be changed to malignant processes due to relapse or metastasis observed over time. The purpose of the study was to optimize the differential diagnosis of FA and follicular thyroid carcinoma (FTC) using the immunohistochemical (IHC) marker HBME-1 on the histological material of patients who were operated for nodular goiter with a cytological conclusion corresponding to the Bethesda categories III–V. Materials and methods. One hundred and twenty-four patients underwent surgery for follicular nodular neoplasms with a cytological conclusion according to Bethesda Gray zone and had a histological diagnosis of FTC in 23 ca­ses (18.55 %) and FA in 101 cases (81.45 %). IHC analysis was performed using mouse monoclonal antibodies against human HBME-1 (Bio SB, USA). Evaluation criteria corresponded to the strength of staining (from 0 to 3). Results. According to the intensity of IHC staining, there was an increase in the diagnosis of FTC (p < 0.05): 0 — 0 %, 1 — 12.7 %, 2 — 25 %, 3 — 36.4 %. Histopathological findings were reexamined for FA that had the strongest staining reaction: in 3 (2.97 %) cases, the diagnosis was changed to FTC. Accor­dingly, the total number of detected FTC increased to 26 (20.96 %). These cases showed a good positive result regarding IHC study with HMBE-1 on FA preparations for a differential diagnosis between FA and FTC. Conclusions. HBME-1 can serve as an IHC marker for the differential diagnosis of FA and FTC in cases considered as FA, as after the study, the diagnosis was changed to FTC in 2.97 % of patients.

Prognosis impact and clinical findings in renal cancer patients: comparative analysis between public and private health coverage in a cross-sectional and multicenter context.

Research on disparities in prognosis and clinical characteristics between public and private healthcare sectors in developing countries remains limited. The study aimed to determine whether patients with public health coverage (1) have a greater mean tumor size at diagnosis compared to those with private health coverage; (2) exhibit differences in clinical staging and TNM classification between groups; and (3) show variations in demographic, clinical characteristics, histopathological findings, and surgical approaches among cohorts. A cross-sectional, multicenter study was conducted on 629 patients from both private and public healthcare sectors, all histologically confirmed and surgically treated for Renal Cell Carcinoma (RCC), between 2011 and 2021 in high-volume hospitals in Monterrey, Mexico. To compare variables between groups, we employed independent samples t-tests, Mann Whitney U nonparametric test, along with Pearson's chi-square test complemented by post hoc analyses. Mean tumor size in the public group was 1.9cm greater than in the private group (7.39 vs. 5.51cm, p < 0.001). Patients in the public sector more frequently presented with larger tumors, a higher prevalence of risk factors (excluding BMI and hypertension), advanced disease (OR 2.12, 95% CI 1.43-3.16, p < 0.001), presence of symptoms, elevated TNM, lymphovascular invasion and a lower prevalence of minimally invasive surgery. A male-to-female ratio of 2.6:1 was noted in the private coverage group. This study highlights a notable association between public health coverage and a higher prevalence of advanced RCC, with tumors in private coverage patients being smaller yet larger than commonly reported. There is a crucial need to develop new health policies for early detection of renal cancer in developing countries.

Efficacy of additional lateral pinhole and SPECT/CT imaging in dual-phase Tc-99m MIBI parathyroid scintigraphy for localising parathyroid pathologies in patients with primary hyperparathyroidism: a single-institution experience.

Parathyroid imaging with dual-phase technetium-99m methoxyisobutrylizonitrile (Tc-99m MIBI) scintigraphy serves as an important prerequisite for the identification of hyperfunctioning parathyroid gland(s) in patients with primary hyperparathyroidism (PHPT) for a successful targeted parathyroidectomy. This study aimed to evaluate the clinical value of additional lateral imaging and single-photon emission computed tomography/computed tomography (SPECT/CT) versus conventional planar imaging for locating parathyroid pathologies in patients with PHPT. A retrospective review was performed on 105 patients who underwent dual-phase Tc-99m MIBI scintigraphy and were surgically treated by parathyroidectomy. Dual-phase Tc-99m-MIBI planar scintigraphy with additional lateral pinhole views and SPECT/CT imaging was performed on a routine basis, as per departmental protocol. Comparison study between imaging modalities was done by patient-based analysis and scintigraphy results were compared with the clinical findings, biochemical markers, and histopathological findings. Sensitivity and specificity for anterior planar dual-phase Tc-99m MIBI scintigraphy were 78.8 and 80%, respectively. In comparison, lateral pinhole scan and SPECT/CT alone were found to have sensitivities of 85.9 and 90.9%, respectively, with the same specificity. Sensitivity decreased in patients with normocalcaemia and multiglandular disease. The mean adenoma weight and size for true-positive studies were significantly higher than those for false-negative or false-positive studies. SPECT/CT provided the highest diagnostic accuracy for preoperative identification of parathyroid lesions in PHPT patients. Lateral pinhole imaging offers comparable sensitivity and aids in adenoma localisation when SPECT/CT is unavailable.

Detection of DNA of Leishmania infantum in the brains of dogs without neurological signs in an endemic region for leishmaniasis in the state of Rio Grande do Sul, Brazil.

Canine visceral leishmaniasis (CVL) is a parasitic disease caused by the protozoan Leishmania infantum. Neurological infection occurs due to the parasite's ability to cross the blood-brain barrier. It is known that dogs can remain infected with a subclinical infection for life, potentially acting as reservoirs for L. infantum when bitten by sandflies. In this context, the objective of this study was to evaluate the occurrence of Leishmania spp. in the brains of dogs from the metropolitan region of Rio Grande do Sul, Brazil, without a history of neurological disease but residing in an endemic area for L. infantum. A total of 200 samples, from 2022 to 2023, were evaluated using conventional Polymerase Chain Reaction (PCR) with the primers Leishmini-F GGKAGGGGCGTTCTGC and Leishmini-R STATWTTACACCAACCCC, aiming to amplify a product of 120 base pairs for Leishmania spp. To identify the species, a multiplex PCR was used, differentiating L. braziliensis (127bp), L. amazonensis (100bp), and L. infantum (60bp), with the molecular target being the conserved region of the kinetoplast DNA (kDNA) minicircle, specific to Leishmania spp. Of the 200 samples evaluated, 26.5% (53/200) tested positive in the conventional PCR reaction for Leishmania spp., with the PCR multiplex the only species detected was Leishmania infantum. The average age of the positive animals was 5.08years, with 47.2% being females and 52.8% being males; among these, mixed-breed dogs were the most predominant, representing 43.4% of the total. Clinical signs varied: hepatomegaly in two dogs, pronounced neutrophilic hepatitis in one, splenomegaly in one with lymphoid hyperplasia, and glomerulonephritis and nephritis in two animals. Mild anemia and thrombocytopenia were found in eight, with pale mucous membranes in three, and diffuse alveolar edema in one case. Notable pathological findings included suspected distemper in one animal and lymphoplasmacytic meningitis in another. Histopathological findings revealed alveolar edema and acute renal failure. A third dog exhibited bilateral hydrocephalus and diffuse edema in the brain. Additional changes, such as mild inflammatory infiltrate and slight vacuolar degeneration, were observed in 11.3% of the analyzed brains. There was no clinical suspicion of leishmaniasis in any of the studied cases. Therefore, the detection of L. infantum DNA in the brains of dogs suggests that animals with subclinical infection may play a crucial role in the spread of leishmaniasis, and infection by Leishmania spp. should be considered as a differential diagnosis for neurological disease in endemic areas for the protozoan.

Tattoo-induced immunologic reaction to red inks

A 43-year-old male presented with pruritic nodular lesions in the red dye area of his leg tattoo, which developed 4 weeks after its application. Patch tests were performed using a standard series, and the inks used by the tattooist were tested semi-open. Tests identified a sensitization to 2 inks containing an azo-organic dye (Pigment Red 170), diketopyrrolopyrrole (Pigment Red 254), and copper phthalocyanine (Pigment Blue 15). Histopathological findings suggested a pseudolymphoid reaction, likely driven by T-cell hypersensitivity to the red pigments. Although the utility of patch testing in the assessment of tattoo reactions is not consensual, it can be useful in identifying the offending inks, helping to guide future tattoo choices and prevent recurrences. Patch testing including the suspected ink should not be disregarded from the diagnostic workup.

A novel small molecule phagocytosis inhibitor, KB-208, ameliorates ITP in mouse models with similar efficacy as IVIG.

The characteristic feature of immune cytopenias involves the process of extravascular phagocytosis, wherein macrophages in the spleen and/or liver engage in the destruction of blood cells that have been opsonized by auto- or alloantibodies. Therefore, new treatments that prevent phagocytosis will be advantageous, especially for short-term usage along with alternative options. KB-208, a small molecule drug, previously shown to be efficacious for the in vitro inhibition of phagocytosis was synthesized. A passive antibody mouse model of immune thrombocytopenia (ITP) was used. Three different mouse strains (BALB/c, C57BL/6, CD1) were used to determine the efficacy of KB-208 compared with IVIG to ameliorate the ITP. Toxicity was investigated after 60-day chronic administration of KB-208 by a biochemistry panel, gross necroscopy and histopathology. KB-208 showed similar efficacy to ameliorate the thrombocytopenia compared with IVIG in all three mouse strains. This small molecule drug was effective at 1 mg/kg in ameliorating ITP, in comparison with IVIG at 1000-2500 mg/kg. KB-208 did not affect other blood parameters or elevate serum biochemistry markers of toxicity nor were any abnormal histopathological findings found. KB-208 is similar to IVIG for the amelioration of ITP in multiple mouse strains. Chronic administration of KB-208 for 60 days did not demonstrate in vivo toxicity. These findings indicate that KB-208 is efficacious, without significant in vivo toxicities in mice, and is a potential small molecule candidate for further evaluation to be used in the treatment of ITP and possibly all immune cytopenias where phagocytosis is responsible for the pathophysiology.

Histopathologic Comparisons of Discoid Lupus Erythematosus and Folliculotropic Mycosis Fungoides in a Series of 43 Cases.

Folliculotropic mycosis fungoides (FMF) is a rare cutaneous malignancy that can be mistaken for inflammatory diseases, such as discoid lupus erythematosus (DLE), due to the variability of histopathological findings. This study aims to provide dermatopathologists with evidence-based histopathologic criteria to distinguish DLE from FMF by reporting overlapping and distinguishing microscopic features. Forty-three biopsies from patients with a confirmed diagnosis of DLE or FMF were graded for the presence or absence of 18 histopathologic features. The main histopathologic findings present in nearly all DLE and FMF biopsies were folliculocentric and folliculotropic patterns. Comedones, granulomas, and folliculitis were not prominent. Follicular hyperplasia, follicular plugging, interstitial mucin, lichenoid/interface dermatitis, and plasma cells were significantly more common in DLE biopsies, while follicular mucinosis and eosinophils were significantly more common in FMF samples. Cytologic atypia ranged from none to mild in DLE and mild to moderate in FMF. Rarely, both sets of biopsies contained epidermotropism, spongiosis, or peri-eccrine infiltration. While many histopathological features present in DLE overlap with features found in FMF, such as folliculocentrism and folliculotropism, significant differences do exist. Therefore, when diagnosing FMF, it is important to follow established criteria that differentiate this malignancy from inflammatory conditions such as DLE.

Is histopathological analysis necessary in patients undergoing sigmoidectomy for diverticular disease? A retrospective study.

The purpose of this study was to assess the utility of routine histopathological examination in patients undergoing elective sigmoidectomy for diverticular disease after full colonoscopy 1 year prior to surgery. We retrospectively analysed medical records of all patients undergoing sigmoidectomy for diverticular disease with a documented colonoscopy within 1 year before surgery from January 2013 to December 2023. We collected preoperative, intraoperative and postoperative data of all patients. The primary endpoint was the percentage of patients with an unexpectedly abnormal histopathological report compared to colonoscopy. During the study period, 207 patients undergoing sigmoidectomy for diverticular disease were included. Mean age was 62.7 ± 13.0 years and 97 (46.9%) patients were men. In eight (3.9%) cases an unexpected finding was noted on the histopathological examination: five (2.4%) of them were hyperplastic polyps with no dysplasia and no clinical relevance, two (1.0%) were polyps with low-grade dysplasia and in one case (0.5%) a diffuse large B-cell lymphoma was present in a patient with history of lymphoma treated in the past 10 years. The Goodman and Kruskal's G index was 0.953 (95% lower limit of 0.913), which indicated high concordance between the colonoscopy and the definitive histopathological examination. In our series, the preoperative colonoscopy reliably predicted the result of the histopathological specimen findings in patients undergoing sigmoidectomy for diverticular disease. Only one (0.5%) high-risk patient had an unexpected clinically significant finding. Therefore, routine histopathological examination may not be justified for all patients.

Rapidly Developing and Elusive Rhino-Orbital-Cerebral Mucormycosis

Purpose: To report a case of rapidly progressing rhino-orbital cerebral mucormycosis that was particularly difficult to diagnose, initially presenting as orbital apex syndrome. Major findings: In this case, a 59-year-old male patient with uncontrolled diabetes presented with a history of facial pain with no ocular involvement. Within 1 day of hospitalization, the patient developed complete ophthalmoplegia and total visual impairment of the right eye. Over the course of 2 hospital stays, several biopsies resulted in no significant histopathological findings, and several cultures resulted in growth of only a single colony of rhizopus mucor from the sinonasal mucosa. Given the high clinical suspicion of an invasive fungal infection, a universal PCR test was performed from a rapidly developing abscess in the frontal lobe and confirmed a diagnosis of mucormycosis. Conclusions: Orbital apex syndrome is a significant diagnosis that can be caused by a variety of factors, including those of fungal, bacterial, neoplastic, or inflammatory origin. Fungal infections, are a particularly concerning cause of orbital apex syndrome, given their ability to penetrate in and through the orbit to the brain, often resulting in an alarmingly high mortality rate. Mucormycosis, specifically rhino-orbital cerebral mucormycosis, is a very severe opportunistic invasive fungal infection, most often afflicting the immunocompromised. A clinician must be very thorough in their workup so as to not miss such a devastating diagnosis. Histopathology and cell cultures are currently the gold standard for diagnosis, with the potential to augment their technical success through the use of molecular techniques, such as universal PCR.