Gland Involvement Research Articles

Nephrotic Syndrome Following Resection of an Adrenal Incidentaloma:A Case Report

A 69 year old man had a 5 cm right adrenal lesion discovered incidentally while being investigated for a deterioration in previously well-controlled hypertension. Routine investigations including serum albumin were normal. Further investigation confirmed a non-functioning adrenal lesion. MRI revealed a ‘non-fat-containing T1 hyperintense indeterminate adrenal lesion with speckling of T2 hyperintensity, not typical for adenoma, hyperplasia, myelolipoma, haemangioma or pheochromocytoma’. An uncomplicated laparoscopic adrenalectomy was performed. Histology revealed a 118 g adrenal neoplasm, modified Weiss score 0, with abundant hyaline deposits.3 months later the patient complained of peripheral oedema. Investigations revealed a serum albumin of 24 g/L and 14 g of proteinuria in 24 hours. Serum protein electrophoresis revealed a monoclonal IgA type lambda band. Renal biopsy revealed amorphous material displaying apple green birefringence on staining with Congo Red, which stained with antibodies to lambda light chains, confirming AL amyloid. Therefore the patient’s resected adrenal specimen was retrieved and stained with Congo Red, revealing apple green birefringence in the walls of the blood vessels, confirming the presence of amyloidosis. Although adrenal gland involvement in secondary amyloidosis is common, adrenal involvement in primary amyloidosis is less well described. This case illustrates the indolent nature of primary amyloidosis, prior to the development of often catastrophic symptoms. Consideration should be given to Congo Red staining of resected pathologic specimens containing hyaline deposition, to potentially allow for earlier recognition of this devastating disease. A pathophysiologic link between the patient’s incidentaloma, adrenalectomy, and onset of nephrotic syndrome remains a matter for conjecture.

Kimura's disease: a neoplasm mimicking, a rare benign form of chronic inflammatory disorder

Background: Kimura's Disease (KD) is a benign, rare form of chronic inflammatory disease of unknown origin, almost exclusively found in Asian males in their second to fourth decades of life. This rare condition is mostly present as soft tissue mass consists of multiple painless solitary subcutaneous nodules mostly localized in the head and neck region, with coexisting lymph node enlargement and eosinophilia. This case study aims to describe Kimura's Disease (KD) characteristics and give an insight into the role of Computed Tomography (CT) scan in identifying KD and its imaging characteristics.Case Presentation: We reported a case of an Asian man with a history of 18 years left-sided painless facial mass, gradually increase in size with no history of hoarseness, epistaxis, previous facial mass or malignancy, and familial malignancy. CT scan findings showed an inhomogeneous contrast enhancement soft tissue mass located on the left parotid-submandibular region with multiple neck lymphadenopathy and left parotid gland involvement. Eosinophilia was found persistently in the laboratory outcomes, and this mass had been confirmed with histological findings consistent with KD features.Conclusion: Recognizing the characteristics of KD and the imaging findings on Ultrasound and CT-scan as accessible and first-line diagnostic tools, might help in facilitating the diagnosis, making a decision and sparing the patient from unnecessary and harmful procedures.

Distribution and determinants of submandibular gland involvement in oral cavity squamous cell carcinoma

IntroductionThough the submandibular gland (SMG) is routinely sacrificed for several reasons during neck dissection in patients undergoing curative surgery for oral cavity cancers, it might be an innocent bystander and should be considered for preservation. This study aimed to identify the incidence, different patterns of invasion, and risk factors of SMG involvement in oral cavity squamous cell carcinoma (SCC). MethodsThis was a retrospective study of the patients who underwent upfront curative surgery for a biopsy-proven oral cavity SCC. A consistent protocol-based treatment strategy was followed during the study period. Data about clinical profile including demographics, clinical and histology details, and treatment profile were extracted and analysed. ResultsA total of 303 patients underwent unilateral and bilateral neck dissections contributing 79.2% (n = 240) and 20.8% (n = 63) of patients respectively. The common primary sites were buccal mucosa (n = 129, 42.5%), tongue (n = 100, 33.0%) and alveolar gingiva (n = 52, 17.2%). A total of four SMGs showed tumor involvement resulting in a prevalence of 1.09% per neck dissection (n = 366) and 1.32% per patient (n = 303). Of these four cases of SMG involvement, one patient with alveolar cancer had direct tumor invasion while the other three (alveolar cancer – two, tongue cancer – one) patients had neck node metastasis. ConclusionThe present study confirms a very low incidence of SMG involvement in patients with oral cavity cancer who undergo neck dissection. It is often observed in patients with high neck node burden (≥N2 disease and the presence of extracapsular spread) or direct invasion by the primary tumor.

Ultrasonic Characteristics of Medullary Thyroid Carcinoma: Differential From Papillary Thyroid Carcinoma and Benign Thyroid Nodule.

The aim of this study was to evaluate the differences in ultrasonic features of patients with medullary thyroid carcinoma (MTC), papillary thyroid carcinoma (PTC), and benign thyroid nodules. This study included 53 cases of MTC, 151 cases of PTC, and 200 cases of benign thyroid nodule which were pathologically confirmed. There were no significant differences in sex and thyroid gland involvement among the MTC, PTC, and benign thyroid nodule groups. The age among the 3 groups was statistically different (P = 0.002). The TNM stage of MTC was significantly higher than that of PTC (P < 0.001). Compared with PTC, the lesion size, shape, margin, echogenicity, internal nodule component, and blood flow were significantly different in MTC (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P = 0.045, P < 0.001). However, there were no differences in the form of calcification and cervical lymph node involvement between the 2 groups (P = 0.671, P = 0.128). Except for the lesion size and shape (P = 0.068, P = 0.444), MTC group have significant differences in the grade of Thyroid Imaging Reporting and Data System, lesion margin, echogenicity, internal nodule component, calcification, cervical lymph node, and blood flow compared with benign thyroid nodule group (P < 0.001, P = 0.014, P = 0.032, P < 0.001, P < 0.001, P < 0.001). Our data indicate that ultrasound have important value in preoperative diagnosis of MTC. The ultrasonic features of MTC include relatively large nodules, aspect ratio less than 1, smooth edge, solid hypoechoic, microcalcification, and rich blood flow. It is necessary to combine multiple ultrasonic features for the differential diagnosis of MTC, PTC, and benign thyroid nodules.

Clinical characteristics of endocrinopathies in Chinese patients with hereditary haemochromatosis.

Hereditary haemochromatosis (HH) is a genetic disorder characterised by systemic iron overload and can lead to end-organ failure. However, very few data on this disorder, especially those on endocrine gland involvement in Chinese populations, are currently available. This study aimed to analyse the clinical features of endocrinopathies in patients with HH to generate concern among endocrinologists and improve the management of this disorder. Chinese patients with HH-related endocrine dysfunction were enrolled at Peking Union Medical College Hospital from January 2010 to December 2018. All clinical data were analysed and summarised. A total of six patients were enrolled in this study, comprising five men and one woman; the average age was 36.5±13.3 years. Mean serum ferritin concentration was 4508.8±1074.3ng/ml, and median transferrin saturation was 97.9% (96.6%-110.0%). Endocrine gland involvement associated with HH included the pancreas (5/6 patients), the adenohypophysis (5/6 patients) and the bones (1/6 patients); secondary endocrinopathies consisted of diabetes mellitus, hypogonadism, adrenal insufficiency and osteoporosis. Based on phlebotomy and iron chelation therapy, five patients were treated with exogenous insulin preparations, and three patients were treated with exogenous sex hormone replacement therapy. The clinical symptoms of five patients improved, although one patient died of hepatic encephalopathy and multiple organ failure. HH can cause multiple endocrinopathies. The possibility of HH should be carefully considered in patients with endocrine gland dysfunctions and concomitant elevated serum ferritin levels. Endocrine gland function should also be assessed and followed up in patients with a clear diagnosis of HH.

Application of the OMERACT Grey-scale Ultrasound Scoring System for salivary glands in a single-centre cohort of patients with suspected Sjögren’s syndrome

AimTo describe salivary gland involvement in patients suspected of Sjögren’s syndrome (SS) using the OMERACT Ultrasound Scoring System for SS. Next, using different ultrasound cut-offs, to assess the performance of...

Clinical features and relapse risks of IgG4-related ophthalmic disease: a single-center experience in China

BackgroundIgG4-related ophthalmic disease (IgG4-ROD) is one of the phenotypes of IgG4-related disease (IgG4-RD), and its lesions are mainly located in the ocular. Currently, there are few studies on IgG4-ROD and no study has compared the phenotypic differences between IgG4-ROD and non IgG4-ROD (nIgG4-ROD). Thus, it is difficult to establish the optimal treatment strategy for IgG4-ROD. The aim of this study was to identify the disparities between the two groups and to clarify the risk factors for IgG4-ROD relapse.Methods434 IgG4-RD patients met comprehensive diagnostic criteria and diagnosed at Peking University People’s Hospital between January 2009 and January 2020 were recruited in this study. Patients were divided into IgG4-ROD and nIgG4-ROD group according to the ophthalmic involvement. Demographic, clinical, and laboratory data of two groups were collected and compared. Cox regression analysis was used to identify the independent risk factors for IgG4-ROD relapse.Results255 IgG4-ROD patients were identified in this study. IgG4-ROD group had almost equal sex ratio, younger age of disease onset and diagnosis comparing with nIgG4-ROD patients. As compared to nIgG4-ROD group, higher percentage of IgG4-ROD patients met the 2019 American College of Rheumatology/European League Against Rheumatism classification criteria (AECC) for IgG4-RD; moreover, IgG4-ROD patients had higher AECC scores and IgG4-RD responder index (RI). Allergic diseases and multiorgan involvement were more common in IgG4-ROD group. IgG4-ROD was frequently associated with salivary gland, paranasal sinus, lung, and lymph node involvement, while retroperitoneal fibrosis and biliary system lesions were more common in nIgG4-ROD. IgG4-ROD patients had higher serum IgG4 levels, IgG4/IgG ratio, IgE levels, and lower CRP levels. The initial glucocorticoid plus immunosuppressant was a protective factor for IgG4-ROD relapse. IgG4-ROD patients treated with initial glucocorticoid plus immunosuppressant had longer relapse-free survival time than patients treated with initial glucocorticoid monotherapy.ConclusionsIgG4-ROD patients had distinctive clinical features compared with nIgG4-ROD patients. The initial glucocorticoid plus immunosuppressant was a protective factor for IgG4-ROD relapse, which could prolong the relapse-free survival time of IgG4-ROD patients. These findings may have important implications for understanding and management of IgG4-ROD.

Clinical Outcomes of Salivary Gland Tumor Surgery: A 10-year-chart View

ABSTRACT Background Salivary gland tumors constitute about 3% of all head and neck tumors. We present a series of 104 cases of various salivary gland pathologies and the various modalities of surgeries done between January 2007 and July 2017. Materials and methods Total 104 patients with salivary gland tumors were included in this study, of which 76 patients had parotid tumors and 28 were submandibular gland tumors. The presence or absence of coexisting salivary gland stones, involvement or noninvolvement of ducts were all considered. Preoperatively, patients underwent fine needle aspiration cytology (FNAC) and imaging studies along with routine blood investigations. Results All patients underwent surgery and subsequent histopathological examination (HPE). The preoperative FNAC and postoperative HPE were not correlating in 6.5% of parotid tumors and in 3.5% of submandibular gland tumor. Anomalies in the fasciovenous planes were seen in 3% of the patients, which caused intraoperative difficulties. Postoperatively, five patients had salivary leak and three patients had neuropraxia, which was managed conservatively and the patients recovered subsequently between 3 months and 6 months postoperatively. Conclusion Surgery for salivary gland tumors has its own threats due to the close proximity of nerve, vessels, and ducts. Postoperative complications like nerve palsy is seen more common in malignant tumors in both parotid and submandibular gland tumors. A proper methodical assessment and awareness of the various anatomical anomalies intraoperatively may give good surgical outcomes in surgeries of salivary gland tumors. In our study, various anomalies were encountered and dealt appropriately. How to cite this article Vemuru T, Mohanty S, Manimaran V, et al. Clinical Outcomes of Salivary Gland Tumor Surgery: A 10-year-chart View. Int J Head Neck Surg 2021;12(1):11–14.

Meibomian Gland Dysfunction in Ocular Graft vs. Host Disease: A Need for Pre-Clinical Models and Deeper Insights

Despite decades of experience with hematopoietic stem cell transplantation, we are still faced with the delicate equipoise of achieving stable ocular health post-transplantation. This is because ocular graft-versus-host disease (oGvHD) following hematopoietic stem cell transplantation frequently occurs (≥50%) among transplant patients. To date, our understanding of the pathophysiology of oGvHD especially the involvement of the meibomian gland is still limited as a result of a lack of suitable preclinical models among other. Herein, the current state of the etiology and, pathophysiology of oGvHD based on existing pre-clinical models are reviewed. The need for additional pre-clinical models and knowledge about the involvement of the meibomian glands in oGvHD are emphasized.

Evaluation of salivary gland tumors- clinically radiologically and pathologically: prospective study

&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Salivary gland tumors are difficult to differentiate based solely on clinical presentation or cytological findings due to their overlapping pictures. Often inadequate samples from cytology pose a challenge in preoperative diagnosis. Histopathology is considered the gold standard in diagnosing these tumors. The purpose of this study was to determine clinical, radiological, and cytological findings of these tumors and to assess the accuracy of these results with that of histopathological diagnosis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Prospectively 52 patients with salivary gland swellings were enrolled between 2007-2009. Cases with inflammatory swelling were excluded from the study. Demographic, clinical history, preoperatively ultrasonography, cytology, and histopathological data were collected and analyzed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Most cases (65.38%) had parotid gland involvement. Benign tumors were common (80.76%) with pleomorphic adenoma as the most common one. Malignant tumors comprised 19.23%. Mucoepidermoid carcinoma and adenoid cystic carcinoma were common malignant tumors. Local swelling was the most common clinical presentation, and no facial nerve involvement was reported. The hard palate was the most common minor salivary gland affected predominantly by benign tumors. The diagnostic accuracy of fine-needle aspiration cytology was 96.15%, followed by clinical and radiological diagnostic accuracy of 92.31% and 86.54%, respectively. Using McNemar's test, a significant agreement was found between clinical and histological diagnosis (p=0.1336) and between FNAC and histological diagnosis (p=0.4975).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Fine needle aspiration cytology is a highly accurate, sensitive, and specific screening technique. It is safe and reliable, though minimally invasive. Ultrasonography-guided cytology along with clinical, and radiological findings could enhance the pre-operative diagnostic accuracy in distinguishing salivary gland tumors.&lt;/p&gt;

Effectiveness of ultrasonography and shear wave sonoelastography in Sjögren syndrome with salivary gland involvement.

PurposeThis study investigated the effectiveness of major salivary gland ultrasonography (MSGUS) using a new grading system and shear wave elastography (SWE) in evaluating the major salivary glands of patients with Sjögren syndrome (SjS).MethodsThis prospectively-designed cross-sectional study included 49 SjS patients and 49 healthy controls. Major salivary glands were examined with gray-scale ultrasonography and SWE. A new grading system for salivary glands was developed using MSGUS findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MSGUS and shear wave velocity (SWV) values were investigated. The MSGUS grading system and SWV values were evaluated together by logistic regression analysis. A cutoff value of SWE for salivary glands was determined.ResultsThe sensitivity, specificity, PPV, and NPV of MSGUS were 69.4%, 73.5%, 72.3%, and 70.6% for the submandibular gland and 69.4%, 65.3%, 66.7%, and 68.1% for the parotid gland, respectively. The mean SWV values of the parotid and submandibular glands were significantly higher in SjS patients than in controls (P<0.05). The sensitivity, specificity, PPV, and NPV for the submandibular gland (cutoff, 1.95 m/s) and the parotid gland (cutoff, 2.39 m/s) were 69.4%, 52%, 59.1%, and 63% and 82.7%, 83.7%, 83.5%, and 82.8%, respectively. Adding SWE to the parotid gland grading system increased the sensitivity and specificity (sensitivity, 82.7%; specificity, 83.7%).ConclusionEvaluating the salivary glands using MSGUS with a new grading system and SWE may contribute to the diagnosis of SjS. The combination of MSGUS and SWE may be a promising tool for diagnosing SjS.

Eosinophilic sialodochitis: An emerging atopic condition

To report the clinical characteristics of the largest single centre cohort of patients with eosinophilic sialodochitis. Analysis of data relating to 37 patients seen in a dedicated multidisciplinary clinic was performed. Demographic, clinical, haematological, cytological, histological and radiological features were collated. Response to trials of allergy treatment was assessed. Thirty-seven patients (30 female, seven male) were identified, 42% of whom were of Afro-Caribbean origin, with a mean age of 50.4years (range 28-80years). Mean symptom duration at presentation was 10years (range 2-33years). Parotid and submandibular gland involvement was equally reported. The most commonly reported symptoms were swelling (97%), itching of the overlying skin (92%), salivary gland discomfort (84%) and "string-like" mucus discharge from salivary duct orifices (76%). Twenty-three patients (62%) demonstrated atopic disease and serum IgE level elevated in 57%. All 37 patients had eosinophils present in aspirated duct contents samples while raised peripheral eosinophil count was seen in 41%. Anecdotal symptom improvement was reported with antihistamine, antileukotriene or steroid treatment. Eosinophilic sialodochitis should be considered in any patient presenting with recurrent salivary gland swelling. Further studies are needed to evaluate treatments directed at a likely allergic pathogenesis.

Allergy-Related Sialodochitis: A Preliminary Cohort Study.

To explore the clinically feasible diagnosis criteria and treatment outcomes of allergy-related sialodochitis (ARS). Prospective Cohort Study. Ninety-six consecutive patients were enrolled by the following criteria: 1) recurrent swelling of ≥2 large salivary glands that lasted for ≥3 months; 2) with mucus plug exudations; 3) with atopic diseases; 4) ductal stenosis and/or ectasia. Sixty-four patients with elevation of peripheral blood eosinophil (PBE) and/or serum IgE level comprised group A (highly-suspected ARS group), while the remaining 32 comprised group B (patients without confirmed evidence of ARS). These patients were treated with interventional endoscopy. A chronic obstructive sialadenitis symptom (COSS) questionnaire was used to quantify the treatment outcomes. In group A, Serum IgE was elevated in 84.4% of patients and PBE was elevated in 34.4% of patients. Percentage of submandibular gland involvement was higher in group A than group B (48.4% vs. 18.8%). On sialograms, the snowflake changes of branch ducts were seen in higher percentage of group A compared with group B (59% vs. 35% for parotid glands, 27% vs. 8% for submandibular glands, respectively). Mucus plug smears showed abundant eosinophils in 14 group A patients. Biopsy of five group A patients revealed significant eosinophil infiltration around the main and interlobular ducts. During follow-up, the COSS scores were significantly decreased in both groups, and group B was improved better than group A. PBE and serum IgE are important diagnostic indexes of ARS. Mucus plug smear or histopathology verifies the diagnosis. Interventional endoscopy is helpful for ARS cases. 3 Laryngoscope, 131:2030-2035, 2021.

Ultrasound and Bioptic Investigation of Patients with Primary Sjögren's Syndrome.

Primary Sjögren’s syndrome (pSS) is a chronic and heterogeneous disorder characterized by a wide spectrum of glandular and extra-glandular features. The hallmark of pSS is considered to be the immune-mediated involvement of the exocrine glands and B-cell hyperactivation. This leads pSS patients to an increased risk of developing lymphoproliferative diseases, and persistent (>2 months) major salivary gland enlargement is a well-known clinical sign of possible involvement by B cell lymphoma. Better stratification of the patients may improve understanding of the mechanism underlying the risk of lymphoproliferative disorder. Here, we summarize the role of different imaging techniques and a bioptic approach in pSS patients, focusing mainly on the role of salivary gland ultrasonography (SGUS) and a US-guided core needle biopsy (Us-guided CNB) as diagnostic and prognostic tools in pSS patients with persistent parotid swelling.

Ophthalmologic Manifestations of Primary Sjögren's Syndrome.

Sjögren’s syndrome (SS) is a chronic, progressive, inflammatory, autoimmune disease, characterized by the lymphocyte infiltration of exocrine glands, especially the lacrimal and salivary, with their consequent destruction. The onset of primary SS (pSS) may remain misunderstood for several years. It usually presents with different types of severity, e.g., dry eye and dry mouth symptoms, due to early involvement of the lacrimal and salivary glands, which may be associated with parotid enlargement and dry eye; keratoconjunctivitis sicca (KCS) is its most common ocular manifestation. It is still doubtful if the extent ocular surface manifestations are secondary to lacrimal or meibomian gland involvement or to the targeting of corneal and conjunctival autoantigens. SS is the most representative cause of aqueous deficient dry eye, and the primary role of the inflammatory process was evidenced. Recent scientific progress in understanding the numerous factors involved in the pathogenesis of pSS was registered, but the exact mechanisms involved still need to be clarified. The unquestionable role of both the innate and adaptive immune system, participating actively in the induction and evolution of the disease, was recognized. The ocular surface inflammation is a central mechanism in pSS leading to the decrease of lacrimal secretion and keratoconjunctival alterations. However, there are controversies about whether the ocular surface involvement is a direct autoimmune target or secondary to the inflammatory process in the lacrimal gland. In this review, we aimed to present actual knowledge relative to the pathogenesis of the pSS, considering the role of innate immunity, adaptive immunity, and genetics.

Abstract PS6-31: Correlations between tumor-infiltrating lymphocytes, CD3, CD8 cells, and Immunoscore®, with pathological CR and time to progression in triple-negative breast cancer patients undergoing neoadjuvant chemotherapy

Abstract Background High levels of stromal tumor-infiltrating lymphocytes (TILs) have been associated with better prognosis in early triple-negative breast cancer (TNBC). The Immunoscore® (IS) is a prognostic tool, which categorizes the densities of spatially positioned CD3 and CD8 cells in both invasive margins (IM) and the center of the tumor (CT), yielding a five-tiered classification (0-4). High IS values have been reported to predict improved outcomes in colorectal cancer. Methods The cohort consisted of 53 TNBC patients (pts) who previously received neoadjuvant anthracycline- and taxane-based chemotherapy. Quantitative analysis of the immune cells was carried out using computer-assisted image analysis in different tumor locations for CD3 and CD8 T-cell markers. Additionally, we measured stromal TILs according to the International TILs Working Group. Pre-treatment tumor samples were immune-stained for CD3 and CD8 T-cell markers and stromal TILs. The relationship between various clinical-pathological factors, and immune factors, was analyzed by Chi2 and Fischer exact test. The log-rank test and the Kaplan Meyer methods were used to estimate relapse-free survival. Results The median age of the pts was 50 years (27-84 years). Tumor sizes were categorized as T1 = 9 pts (17%), T2 = 41 pts (77%) and T3 = 3 pts (6%). Pts with positive glands = 19 (36%) pts and pts without gland involvement = 34 (64%). Stage grouping included stage 1 = 5 (9%), stage IIA = 33 (63%) pts, stage IIB = 9 (17%) pts, stage III = 6 (11%) pts. The median Ki-67 was 45% (range 5 - 90%). The median density of CD3 CT cells = 1190mm² (range 34 - 4614), CD3 IM = 1855mm² (range 57 - 6190), CD8 CT 508mm² (range 17 - 2486) and CD8 IM 805mm² (range 90 - 3156). The median percentage of stromal TILs was 5% (0 - 60%). Pts with an IS of 0 = 4 pts (8%), IS 1 = 3 (5%), IS 2 = 20 pts (38%), IS 3 = 24 pts (45%) and IS 4 = 2 pts (4%). The pathological complete response (pCR) rate of the entire cohort was 62%. A positive correlation was found between TILs and CD3 CT (R = 0.641, p &amp;lt; 0.0000), CD8 CT (R = 0.5623, p &amp;lt; 0.0000), CD3 IM (R = 0.6099, p &amp;lt; 0.0000), and CD8 IM. (R = 0.5010, p &amp;lt; 0.0010). TILs correlated with IS (R = 0,3603, p &amp;lt; 0.0087). There was no correlation between TILs and Ki-67 (R = 0.1497, p &amp;lt; 0.2943). On univariate analysis, factors associated with higher pCR included nodal status (positive = 42,11% vs. negative = 73,53% (p&amp;lt;0,02362) and Ki67 &amp;lt;40%= 33,33% vs. ≥40% = 76,47% (p&amp;lt;0,00235). A high density of CD3 (&amp;gt; than 1100mm2) and CD8 (&amp;gt; than 400mm2) positive T-cells in the CT was associated with higher pCR (CD3 CT: 30% vs. 70%, p=0.00489 and CD8 CT: 30% vs. 70%, p=0.03344). Analysis of CD3 (&amp;gt; than 1200mm2) (CD3 IM: 12% vs 88%, p=0.0.02367) and CD8 in the IM (&amp;gt; than 550mm2) was also significant for an association with pCR (CD8 IM: 23% vs. 77%, p=0.03). High IS (3+4= 73%) vs. intermediate (2=55%) vs. low (0+1=43%) showed a numerical difference that did not, however, reach a statistical significance with pCR (p=0.111). Analysis of TILs ≥ 20% showed a pCR of 76% compared to pts with TILs &amp;lt; 20% with a pCR of 54% (p &amp;lt; 0.12295). A Ki67 ≥40% was associated with a pCR of 76% compared to pts with Ki67 &amp;lt; 40% with a pCR 33% (p &amp;lt; 0.00235). The median time to progression (TTP) of the pts not attaining a pCR was 1600 days compared to those who did attain a pCR with a median PFS not reached yet, but exceeding 1800 days. The TTP of pts with Ki67 &amp;lt; 40% was 1700 days, while the pts with Ki67 ≥40% was not been reached (p &amp;lt; 0.03). At 1800 days, 95% of pts with CD3 &amp;gt; 1100mm2 did not relapse, compared to 75% pts with CD3 ≤ 1100 (p &amp;lt; 0.03). Conclusions This exploratory study shows that analyzing CD3 and CD8 cells in the center of the tumor and invasive margin might be more useful than examining TILs in TNBC pts. Further prospective, well-designed, adequately powered studies are required to confirm these findings. Citation Format: Bernardo Leon Rapoport, Jérôme Galon, Simon Nayler, Aurelie Fugon, Isabelle Boquet, Marine Martel, B Mlecnik, Carol Ann Benn, Teresa Smit, Liezl Heyman, Farhana Moosa, Ronald Anderson. Correlations between tumor-infiltrating lymphocytes, CD3, CD8 cells, and Immunoscore®, with pathological CR and time to progression in triple-negative breast cancer patients undergoing neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-31.

Current concepts in the pathogenesis of cryptoglandular perianal fistula.

Cryptoglandular perianal fistula is a common benign anorectal disorder that is managed mainly with surgery. A fistula is typically defined as a pathological communication between two epithelialized surfaces. More specifically, perianal fistula manifests as an abnormal tract between the anorectal canal and the perianal skin. Perianal fistulas are often characterized by significantly decreased patient quality of life. The cryptoglandular theory of perianal fistulas suggests their development from the proctodeal glands, which originate from the intersphincteric plane and perforate the internal sphincter with their ducts. Involvement of proctodeal glands in the inflammatory process could play a primary role in the formation of cryptoglandular perianal fistula. The objective of this narrative review was to investigate the current knowledge of the pathogenesis of cryptoglandular perianal fistula with the specific aims of characterizing the potential role of proinflammatory factors responsible for the development of chronic inflammation. Further studies are crucial to improve the therapeutic management of cryptoglandular perianal fistulas.

Distal RTA with Hypokalemic Quadriparesis as the Initial Presentation of Primary Sjogren's Syndrome

Sjogren syndrome (SS) is a multisystemic autoimmune disorder with predominant exocrine gland involvement leading to sicca symptoms. Among extraglandular manifestations, renal involvement is commonly seen. Renal involvement can be either tubulointerstitial (TIN) or glomerular, the former being more common.

Not All Küttner Tumors Are IgG4-Related Disease (IgG4-RD)

Küttner tumor is an uncommon cause of salivary gland enlargement that most frequently affects the submandibular gland. More recently it has been considered a manifestation of IgG4-related disease (IgG4-RD) and synonymous with chronic sclerosing sialadenitis (CSS). We present a series of cases to emphasize this clinical entity as a disease pattern and presentation that is separate from IgG4-RD. Retrospective case series of 3 patients with unilateral salivary gland enlargement, or "Küttner tumor," histologically classified as "chronic sclerosing sialadenitis," The clinical history, radiology reports, laboratory studies, and pathology slides were reviewed for each case. Radiology showed discrete unilateral mass-like lesions in all three cases. Immunohistochemistry showed reduced tissue IgG4-positive plasma cells in two cases and increased numbers in one case, but insufficient to diagnose IgG4-RD. Storiform fibrosis was not seen in all cases and did not coincide with increased IgG4-positive plasma cells. A systemic workup, including serum IgG4 levels in two cases, was normal. A brief review of the literature on the spectrum of salivary gland involvement by IgG4-RD is presented. Küttner tumor is not necessarily the same as chronic sclerosing sialadenitis and is not always associated with IgG4-related disease. This report includes the second documented case of Küttner tumor of the sublingual gland.

Clinical, CT scan, and laboratory changes of abscess patients with odontogenic origin admitted to Shiraz acute surgical care center, Iran.

Introduction:Rapid diagnosis of maxillofacial abscess with the odontogenic origin is effective in the treatment of patients. This study aimed to check the clinical evaluation, head, and neck computed tomography (CT) scan, and microbial sensitivity of hospitalized patients diagnosed with maxillofacial abscess admitted to the Maxillofacial Surgery Ward Shaheed Rajaie Surgical Acute Care Center of Shiraz, Iran from 2019-2021.Method:A cross-sectional study was conducted. The sample included patients diagnosed with the abscess of odontogenic origin. Data collection tools included personal profile registration form, chief complainant and clinical evaluation, laboratory test results, pus culture, antibiogram results, and head and neck CT scan changes form. Data was reported with descriptive statistics by SPSS-16 software.Results:The majority of patients were male; infection duration was 10 days; maximum mouth opening size was less than 20 mm in more than half of patients. The scan revealed 41.8% abscess, 36.4% cellulite, and 21.8% mixed abscess and cellulitis. There was 29.1% involvement of salivary glands. The majority of abscesses were unifocal involved in the submandibular space, and the least involvement was in peri mandibular space and carotid sheath. The most common organism causing was staphylococcal abscess coagulase-negative.Conclusion:In patients with maxillofacial abscess requiring hospitalization, the most common clinical features were trismus, toxic appearance, and dysphagia, and the most common source of abscess in scanning patients with mandibular molars was the most involved submandibular space and pterygomandibular space. Vancomycin, cotrimoxazole, and cefazolin had the greatest effect in the treatment of odontogenic infections in terms of antibiogram results and microbial culture.