Lymphoplasmocytic Infiltration Research Articles

Burned-out testicular cancer - case report

Introduction and Purpose Germ cell tumors of the testis are the most common malignant tumors in young men aged 15-40, although their incidence in the male population is about 1-1.5%. 90-98% of all testicular tumors originate from germ cells. There has been an increase in the incidence of testicular tumors in recent years, suggesting the influence of both genetic and environmental factors. Testicular cancer, which accounts for about 5% of all urological cancers and mainly affects young men. Most of these cancers originate from germ cells, and cases of spontaneous tumor regression are extremely rare. Aim of the study We present the case of a 36-year-old man who was found to have a left testicular tumor with negative tumor markers during physical examination and testicular ultrasound. The tumor was surgically removed, and the patient was discharged home. Histopathological examination showed that the tumor had completely necrosed, and a CT scan showed no metastasis. Results and Future directions The phenomenon of testicular tumor “burnout” has been described since 1927, but it was only in 2016 that the WHO recognized it as a separate disease entity. Despite the rarity of this phenomenon, more and more cases are being reported in the literature, allowing for a better understanding of the underlying mechanisms. It is important to remember that the tumor can give a variable clinical picture and its symptoms are not necessarily related to the location of the tumor, but to its metastasis. Physical and ultrasound examinations are key to making a correct diagnosis. Histologic features such as scar formation, intravesicular calcification, lymphoplasmocytic infiltration and testicular atrophy can help diagnose germ cell tumor. The findings of this case demonstrate the need for diagnostic vigilance, especially in patients with equivocal tumor marker results but with clinical signs of testicular tumor.

A rare pathology that mimics lung cancer: IgG4-related vasculitis.

Immunoglobulin-G4 (IgG4)-related disease is essentially a fibro-inflammatory disease that can affect any organ simultaneously or at different times. The disease usually presents with organ growth that mimics a tumour and can affect the lacrimal glands, major salivary glands, pancreas, bile ducts, retroperitoneal area, lungs, kidneys, aorta, meninges and thyroid gland. The immunopathogenesis behind this new disease has not yet been elucidated. Histopathological distinguishing features of the disease include dense lymphoplasmocytic infiltrates dominated by IgG4 positive plasma cells, storiform fibrosis and obliterative phlebitis. The likelihood of developing with immunoglobulin G4 (IgG4-RD) is a recently identified rare systemic fibroinflammatory disease with an estimated incidence of less than 1 in 100,000 people worldwide. We present our case, which was diagnosed with IGG4-related vasculitis by lung fine needle aspiration biopsy, which is very rare in the literature.

Sino-Orbital IgG4 Related Disease- An Uncommon Entity.

IgG4 related disease (IgG4-RD) is an auto immune fibro-inflammatory condition, characterised by presence of IgG4 positive lymphoplasmacytic infiltrates and extensive fibrosis of the involved organ. It commonly affects pancreas, biliary tract and salivary glands. Sino-orbital involvement is a relatively rare presentation. There is extensive fibrosis of the involved organ. Biopsy is often diagnostic and it shows extensive necrosis and lymphoplasmocytic infiltrates. They show dramatic response to steroid therapy. Here we present three cases of IgG4-RD disease involving orbit and para nasal sinuses who were evaluated and treated in a tertiary care teaching hospital over a period of 2 years.

The post-COVID-19 intestinal damages: clinical, endoscopic and morphological features. The results of a single-center prospective observational cohort study

Background: Clinical signs of gastrointestinal disorders can manifest both from the first days of COVID-19 and after recovery, and may last up to 6 months or more. Most studies examined the gastrointestinal changes in acute coronavirus infection, whereas intestinal abnormalities in the early and late post-COVID period and their causes have not been sufficiently studied.
 Aim: To determine the frequency and types of clinical, endoscopic and morphological abnormalities in patients with post-COVID-19 intestinal lesions.
 Materials and methods: This was a prospective, observational, open-label, cohort, non-controlled study in 72 patients with intestinal symptoms after the coronavirus infection (female 48, mean age 54.6 (95% confidence interval 51.08–58.12) years), who were admitted to the Department of Gastroenterology of general hospital during the first and second waves of COVID-19 from June 2020 to September 2021. The assessment included routine anamnestic, clinical, laboratory, endoscopic, and morphological methods. When indicated, visualization methods (ultrasound, computed tomography, magnetic resonance imaging) were performed. The treatment was symptom-oriented and aimed at inflammation, anemia and protein and electrolyte abnormalities. Outcomes were assessed by the time of discharge from the hospital and thereafter by telephone interviewing of the patients for 8 weeks.
 Results: In all patients, the main symptom was diarrhea, which started right just after SARS-CoV-2 infection with negative PCR test or 2–4 weeks later. The average stool frequency was 6.8 (5.61–7.99) times daily. In 19/72 patients (26.4%), there were blood and mucus in stools. 2.8% of the patients developed massive intestinal bleeding. Fever was present in 40.3% of the patients, decreased hemoglobin levels in 44.4%, and hypoalbuminemia in 16.7%. Signs of systemic inflammation (increased erythrocyte sedimentation rate, C-reactive protein, fibrinogen, thrombocytosis, leukocytosis) were found with various frequencies in a half of the patients. Clostridioides difficile A and B toxins were identified in 38.9% of the cases and increased fecal calprotectin in 22.2%.
 Ileocolonoscopy was performed in 67 patients. The colonic mucosa in 21 (31.3%) patients either was not different from the normal, or showed minimal inflammatory changes such as absence of vascular pattern, hyperemia, mild friability even in patients with severe diarrhea, fever and laboratory abnormalities. Pseudomembranous colitis was diagnosed in 12 (17.9%) patients, and focal hemorrhagic colitis in 11 (16.4%) patients. In 2 (3%) cases, moderate to severe ulcerative colitis was newly diagnosed after the SARS-CoV-2 infection. Single or multiple erosions and ulcers of various sizes against the unchanged surrounding mucosa were found in 19 (28.4%) patients. In 2 (3%) cases with profuse intestinal bleeding, the endoscopy showed diffuse spontaneous bleedings from colonic mucosa, with no local source of bleeding found.
 Biopsy samples from colonic mucosa were taken from 47 patients. Morphological abnormalities of only moderate or dense lymphoplasmocytic infiltration were detected in 29 (67.7%) patients, erosions in 8 (17%). In 2 (4.3%) cases, highly dense lymphoid infiltration with neutrophils, eosinophils and crypt abscesses was found, as typical for ulcerative colitis. In 2 (4.3%) patients, the lymphoid infiltration was associated with small venular and arteriolar clots, and in 5 (10.6%) patients there were no significant morphological abnormalities, except mild lymphoid infiltration.
 During the hospitalization period, 56.9% of the patients showed a decrease in stool frequency, improvement of clinical and laboratory signs of systemic inflammation and metabolic abnormalities, and partial restoration of their body weight. One patient with ulcerative colitis received adalimumab and achieved stable clinical and endoscopic remission. Complete recovery was noted in 27.8% of the cases within 4–8 weeks, among them in 1 patient who had had profuse intestinal bleedings. In 3 cases (4.2%), an emergency colectomy was performed due to severe pseudomembranous colitis. Two (2.8%) deaths were registered: one patient with newly diagnosed post-COVID severe ulcerative colitis died of pneumonia, and another patient died of severe multiorgan failure. In 6 (8.3%) cases, a moderate long-term (above 8 weeks) diarrhea with metabolic disorders, weight loss, but without systemic inflammation was noted.
 Conclusion: In patients with post-COVID intestinal lesions, the clinical symptoms are almost the identical and manifest with diarrhea of varying severity, systemic inflammation and metabolic disorders, whereas the endoscopic and morphological lesions are quite diverse. The severity of clinical symptoms often does not correspond to poorly expressed endoscopic and morphological signs. The variability and inconsistency of the clinical, endoscopic and morphological changes have not yet been systematized and do not allow for a clearly formulated diagnosis (except cases of pseudomembranous and ulcerative colitis). This makes it impossible to provide pathophysiologically-based treatments.

A rare case of Riedel's thyroiditis: Immunoglobulin G4-related thyroid disease

Abstract Introduction Riedel's thyroiditis is a rare thyroiditis in which normal thyroid tissue is replaced by dense fibrous connective tissue. Its etiology is not fully known. An autoimmune process is thought to exist. In this disease group, lymphoplasmocytic tissue infiltration, mostly consisting of IgG4 (+) plasma cells and small lymphocytes, is seen accompanying fibrosis. In our case, we presented a very rare case of Reidel's thyroiditis. Clinical Case We report the case of a 46-year-old woman who came to the general surgery department with an enlargement at the base of her neck. Among the patient's complaints were dysphonia, a feeling of pressure and pain in the neck. She had no history of thyroid disease. Laboratory findings; TSH 0.06 uIU/ml (0.27–4.2), fT3 2.69 pg/mL (2.3–4.5), fT4 1.81 ng/dl (0.93–1.70), crp 73.6 mg/l (0.0–5.0), sedimentation 90 mm/h (0–20), leukocytes 11.74 10^3/ul (4.49–12.68), absolute neutrophil count 9.22 10 ^3/ul (1.9–7.9). Trucut biopsy was performed with the preliminary diagnosis of malignancy due to the history of a mass growing in a short time on the neck of the patient. Pathology result; “Intense fibrosis increase, severe lymphoplasmacytic cell infiltration rich in IgG4 positive cells. Thyroid follicle epithelial cells with ck7, panck, pax8, thyroglobulin, ttf1 positive and cea, ck20, alk negative Intense plasma cells with CD38 have polyclonal staining with kappa and lambda, and IgG4/IgG ratio > 50%. In the background, cd3, pax5 and bcl2 and T cell-rich reactive inflammatory cells are accompanied. Obliterative vascular structures were noted in rust and elastic histochemical stains, and storiform fibrosis was observed in places on the ground. When histopathological and immunohistochemical findings are evaluated together, it is primarily compatible with IgG4-related disease/reidel thyroiditis.'' She was then referred to the endocrinology department. The serum IgG4 level was found to be above normal. She was started on steroid treatment with 64 mg daily methylprednisolone. A weekly control plan was made. In these controls, the steroid dose was gradually reduced. In the follow-up one week later, it was observed that the patient's CRP and sedimentation returned to normal values. There was also a decrease in enlargement in the neck area. In the third month of the treatment, the patient didn't want to continue the treatment. She did not visit our clinic for the next 3 months. Then, she came for the control after three months without treatment. Biochemistry and thyroid function tests were normal. The swelling in the neck area of the patient was completely gone. Conclusion Reidel's thyroiditis is a very rare disease with publications on the basis of case reports in the literature. Therefore, there are no broad-spectrum clinical studies. Clarity on treatment approaches was also not provided. We also benefited from case reports while managing our patient's treatment. We believe that our case will contribute to the literature for the same purpose.

Histological evolution of IgG4 related disease

Histological evolution of IgG4 related disease

Electron microscopy and histopathological examination of canine papilomavirus

Diagnosis of canine papillomavirus (CPV) infection by histopathology, transmission and scanning electron microscopy is presented. The study is based on data obtained by examining nonregressing papillomas (warts) from naturally infected dogs with clinical manifestations of CPV infection. Papules on the mouth and lips were common bilaterally in all dogs. Confirmatory diagnosis of sick dogs was made by clinical findings, histopathology, transmission and scanning electron microscopy. Histopathological examination of hematoxylin and eosin stained papillomas revealed lymphoplasmocytic cell infiltration and fibrosis, parakeratosis in the dermis, papillary proliferation and intranuclear vacuole degeneration in the stratum spinosum. Electron microscopy demonstrated viral icosahedral capsid formation and non-enveloped viral structure of CPV. Transmission electron microscopy demonstrated viral particles and virions in the nuclei of infected cells, viral crystal mode formation in the nucleus. Scanning electron microscopy demonstrated virions and virus-like particles budding in the infected tissue. The findings of the study reveal that electron microscopy and histopathology are effective and sensitive methods in the diagnosis of CPV infection. Electron microscopy is the only imaging technique that allows direct visualization of viruses, along with affected tissues and cells, due to its nanometer-scale resolution. This study reveals the intracellular and extracellular viral pathogenesis, viral ultra structure and structural components of CPV. Present findings indicate canine papillomavirus causes canine papillomatosis, inclusion bodies are common in nonregressive infection, papillomavirus induces cytopathic effect and pathogenesis, viral particles located in the cell and forms crystal mode in nuclear space.

The relationship between colorectal cancer and gastric histopathology: case-control study

Aim: The aim of this study was to investigate the gastric histopathological findings (Helicobacter pylori (H. pylori), intestinal metaplasia (IM), atrophic gastritis (AG), and dysplasia) in the patients with and without colorectal cancer (CRC). Material and Method: Two hundred ninety five patients (160 CRC patients and 135 control individuals) were included in the study. Gastric histopathological findings of the patients who underwent upper gastrointestinal (GI) endoscopy were analyzed retrospectively. Results: H. pylori positivity and IM rates in the CRC patient group were significantly higher than the control group (58.8%&27.8% and 33.1%&19.5%, p<0.001 and p<0.012, respectively). In addition, AG, lymphoplasmocytic infiltration, and dysplasia rates were also higher in the CRC patients compared to the control group. But, they were not statistically significant (p=0.462, p=0.103, and p=0.195, respectively). Conclusion: In our study, the frequency of H. pylori and IM in patients with CRC was higher than in the control group. Since the prevalence of H. pylori infection is high in Turkey and H. pylori-related gastric diseases may be potential risk factors for colorectal neoplasia, it is recommended that individuals in the high-risk group to be screened for colonoscopy. Also, upper GI endoscopic examination should be performed to screen for gastric premaling lesions in patients with CRC.

IgG4-related disease in nasal cavity and paranasal sinuses: a clinicopathological analysis of ten cases

Objective: To study clinicopathological features and differential diagnosis of IgG4-related diseases (IgG4-RD) in nasal cavity and paranasal sinuses. Methods: A retrospective analysis was performed in patients presenting initially with rhinosinusitis or a nasal mass, who also underwent nasal mucosa biopsy in Beijing Tongren Hospital Affiliated to Capital Medical University, from March 2016 to March 2021. According to the latest international classification diagnostic criteria of IgG4-RD published by the American Society of Rheumatology (ACR)/European Association for Rheumatology (EULAR) in 2019, 10 cases of nasal cavity and paranasal sinuses IgG4-RD were diagnosed and included in the study. The clinical features, histopathology and immunohistochemical expression of IgG and IgG4 were analyzed. Results: Among the 10 patients, five patients were male and five female. The age ranged from 30 to 71 years (median 52.7 years). Nasal polyp/nasal masses were seen in six cases, and lacrimal gland swelling was found in four cases. The serum IgG and IgG4 level was increased in four cases. Microscopically, all 10 cases showed intense lymphoplasmocytic infiltration and varying degrees of fibrosis in nasal or sinus mucosa, while four cases showed occlusive vasculitis. The number of IgG4 positive plasma cells in nasal mucosa was more than 10/high power field (HPF), with a mean of 67/HPF. The number of IgG4 positive plasma cells in the cases with severe fibrosis was significantly lower than in those without. The ratio of IgG4+/IgG+plasma cells was higher than 40% in six cases. Conclusions: IgG4-RD in nasal cavity and paranasal sinuses is a local manifestation of a systemic disease, while nasal cavity and paranasal sinuses are rarely involved by IgG4-RD. The diagnosis is based on clinical symptoms, imaging, IgG4-related serology and histopathologic scores. Histopathology has a core diagnostic value. IgG4 serology and imaging have important diagnostic values in the cases without biopsy.

Clinical and histopathological correlation in patients with chronic tonsillitis

<p class="abstract"><strong>Background:</strong> Chronic tonsillitis is diagnosed when an individual has 7 episodes of tonsillitis in 1 year, 5 episodes in 2 consecutive years, or 3 episodes each year for 3 years consecutively. There is correlation of clinical and histopathological findings in patients with chronic tonsillitis.</p><p class="abstract"><strong>Methods:</strong> It is prospective study which is aimed at correlation of clinical and histopathological findings in chronic tonsillitis patients underwent tonsillectomy. This was carried out in tertiary care hospital, Pune, Maharashtra, India. In our study, 25 patients of chronic tonsillitis underwent tonsillectomy were included. In this we have examined the histopathology of tonsillar tissue section in correlation with the clinical manifestations of tonsillar diseases that were due to infection. </p><p class="abstract"><strong>Results:</strong> In pathological examination of palatine tonsil, underlying subepithelial tissue showed many lymphoid follicles with prominent germinal centres comprising of centrocytes, centroblasts, immunoblasts, small and large lymphocytes in 19 patients (76%). 13 patients (52%) showed prominent germinal centres with bites of salivary gland and muscle tissue. 6 patients (24%) showed prominent germinal centre with mild lymphoplasmocytic inflammatory cell infiltrate. In 4 patients (16%), tissue lined by stratified squamous epithelium showed focal ulceration. 3 patients (12%) showed stratified squamous epithelium with granulation tissue. Crush artifact were noted in 3 patients (12%). 2 patients (8%) had small granules with actinomycotic species colonies within the palatine tonsilar crypts. Only 1 patient (4%) showing keratin impacted in tonsilar tissue.</p><p class="abstract"><strong>Conclusions:</strong> There is strong correlation between histopathological examination suggestive of lymphoid hypertrophy and grading of palatine tonsil hypertrophy.</p>

P27 Lymphoma-mimicker of IgG4-related dacryoadenitis and sialadenitis

Case report - IntroductionMajor salivary gland (sialadenitis) and lacrimal gland (dacryoadenitis) involvement can be a common feature of IgG4-related disease. There can be involvement of lacrimal and parotid gland which was previously called as Mikulicz disease and/or submandibular gland enlargement which was previously called Küttner tumour. These were previously mistakenly considered to be subcategories of Sjogren’s syndrome, but are now classified as IgG4-related disease. Here we discuss a case report of a patient who presented with bilateral dacryoadenitis and unilateral submandibular gland enlargement which initially was thought to be IgG4-related disease but turned out to be low-grade lymphoma.Case report - Case descriptionA 15-year-old boy presented with 6-month history of bilateral eyelid swelling. The swelling was more on the lateral side of the eyelids and was painless. It had come on suddenly over a couple of days. No history of weight loss, dry eyes, dry mouth, joint issues or skin rashes or any other symptoms. Physical examination revealed bilateral ptosis, no visual impairment and systemic examination revealed an enlarged right submandibular gland. He had initially been to a local hospital where he had investigations which included autoimmune screen including ANA, ENA, ANCA, dsDNA, serum ace and complement levels which were all negative. C1 esterase inhibitor was normal. Routine bloods including complete blood count, urea and electrolytes, thyroid stimulating hormone and erythrocyte sedimentation rate were within normal limits. Urine albumin to creatinine ratio was not raised. Hepatitis serology including Hepatitis B & C and HIV was negative. Ultrasound abdomen was unremarkable. CT scan of orbits showed bilateral enlarged lacrimal glands with patchy post contrast enhancement and the glands extending up to insertion of lateral rectus muscle. CT chest some enlarged axillary lymph nodes and nodes in lung query infective etiology. CT abdomen and pelvis was unremarkable. Ultrasound neck showed right submandibular node enlargement with colour doppler showing increased vascularity. Fine needle aspirate of the submandibular gland showed reactive lymphoid hyperplasia. He was given two short courses of steroids and each time the swelling rapidly responded to the steroids but recurred on cessation of the steroids. IgG subset analyses revealed elevated IgG4 levels of 1152mg/dl. The differential here was IgG4-related disease but as there was no clear tissue diagnosis a core biopsy of the right submandibular gland was done. This revealed tissue suspicious of low grade (extranodal marginal zone and mucosa-associated lymphoid tissue [MALT]) lymphoma and excision biopsy was performed for definitive diagnosis.Case report - DiscussionIgG4-related disease is an immune mediated fibroinflammatory condition which can affect a variety of organs and can present as tumour-like enlargement and/or organ dysfunction. The pathological findings in IgG4-related disease are lymphoplasmocytic infiltrates of IgG4-positive cells along with increased levels of serum IgG4 levels. Salivary and lacrimal glands can be commonly affected and present as enlargement, which is usually painless and bilateral. The combination of lacrimal gland enlargement with both parotid and submandibular gland enlargement is called IgG4-related Mikulicz disease.Apart from salivary glands, another commonly affected organ is the pancreas which can present as a pancreatic mass and painless jaundice, sclerosing cholangitis, retroperitoneal fibrosis, aortitis and periaortitis. Less commonly it can affect thyroid, kidney and lungs.Early recognition, diagnoses and treatment is important due to the fibroinflammatory nature of the disease. Malignancy is always in the differential and should be excluded. Steroids are the mainstay of treatment. If patients experience flare, rituximab can be added.Diagnosis should be confirmed with biopsy but histopathological findings are never alone diagnostic of IgG4-related disease and should be interpreted with clinical, serological and radiological findings.Case report - Key learning pointsAlthough this patient had typical presentation of IgG4-related disease with painless enlargement of salivary and lacrimal glands and elevated IgG4 serum levels, biopsy was imperative to get to the diagnoses of low-grade lymphoma and fine needle aspirate was not adequate. As mentioned above, biopsy in IgG4-related disease will confirm the diagnosis provided there are other supporting features (radiological and serological). However, it is imperative for excluding other important diseases like lymphoproliferative disorders.

Necrotizing infundibulo-hypophysitis: case-report and literature review

Purpose We describe a rare case of histopathologic-proven necrotizing infundibulo-hypophysitis (NIH). Clinical history A 40-year-old female presented with coexistence of central diabetes insipidus and hypopituitarism. Imaging disclosed a thickened infundibulum and a diffusely enlarged pituitary mass with gadolinium rim enhancement pattern. Microsurgical endonasal transsphenoidal resection was performed. The presence of extensive liquefactive necrosis, surrounded by lymphoplasmocytic inflammatory infiltrate, allowed for the diagnosis of NIH. Follow-up cranial imaging 10 months after surgery showed no evidence of reappearance of the lesion. There was no progression to panhypopituitarism. Conclusion Surgery and histopathological confirmation are the key diagnostic feature in NIH. The current case is the fifth report of NIH and the first one with an indolent course and without progression to panhypopituitarism so far.

Nephro- and hepatotoxicity of uranyl acetate in 18-week chronic administration to rats

The paper presents the results of an experimental study of the hepato- and nephrotoxicity of uranyl acetate dihydrate (UA) in 18-week chronic intragastric administration in doses of 0,5 and 5,0 mg/kg of the element. The study was performed on 45 male mongrel rats. A dose-dependent change in laboratory biochemical parameters of blood and urine of rats treated with the toxicant was revealed. Nephrotoxicity is characterized by multiple disorders of the functions of the proximal and distal tubules and glomeruli of nephrons. A pathoanatomic study revealed gross violations in the liver and kidney cytoarchitectonics of rats treated with UA in a dose of 5,0 mg/ kg. In liver, there were uneven regenerative phenomena in the form of nucleomegaly, the development of granular protein dystrophy of various degrees (up to necrosis), periportal lymphohistiocytic infiltration and periportal fibrosis. In kidneys, there were the development of chronic diffuse tubulointerstitial nephrofibrosis with significant lymphoplasmocytic infiltration, atrophy of the epithelium of the proximal and distal tubules, cystic transformation of the renal parenchyma.

Enfermedad relacionada con IgG4

Immunoglobulin G4-related disease (IgG4-RD) is a fibro-inflammatory condition that can involve all the systems of the organism. This disease has been described relatively recently, in the early decades of the 21st century. Due to this, its aetiology and pathophysiology are not currently sufficiently established. Proof has been growing that the pathogenesis of the disease has an autoimmune foundation, with participation of the memory B cells, T follicular helper (Tfh) cells, T CD4 lymphocytes and macrophages. Initially, the elevation of the IgG fraction 4 (IgG4) serum levels of these patients made it seem that they might be of value in aetiopatogenesis and diagnosis. However, it has later been seen that only about 60% of the patients present elevated serum IgG4 levels. Although almost any organ can be affected, predilections have been defined, principally the salivary glands, orbits and lacrimal glands, pancreas and biliary tree, lungs, kidneys, aorta and retroperitoneal area, meninges and thyroid gland. All the organs affected by IgG4-RD share several histopathological features: lymphoplasmocytic infiltrate with abundant positive IgG4 plasma cells, storiform fibrosis, obliterative phlebitis and eosinophil presence. Diagnosing is complex, given that it requires a combination of clinical, analytical, radiological and histopathological examination. Numerous differential diagnoses also have to be excluded.

The efficiency of the use of polyphenolic grape processing products in the treatment of experimental metabolic syndrome

For 12 weeks, grape polyphenols were used in 30 Wistar rats on the background of a fructose model of metabolic syndrome. All the animals were on a standard food diet. 3 groups of observations were formed: the 1st "control" (10 animals received 100 ml of 2.5% fructose solution daily); the 2nd "experimental" (10 rats were given the drug "Fanokor" with a total content of polyphenols of 181.53 g/dm3, at the rate of 10-15 ml per 1 animal per day in addition to fructose solution); the 3rd "experimental" (10 animals together with a solution of fructose were given the drug "Enoant" with a total content of polyphenols of 4.20 g/dm3, at the rate of 10-15 ml per 1 animal per day). Animals were measured weekly abdominal circumference and body weight. At the end of the experiment, the morphological structure of the liver, kidneys and abdominal fat was studied in all representatives of the comparison groups. The results were analyzed using the methods of variational statistics and Microsoft Excel software. The statistical analysis was carried out using the Mann-Whitney U-test; the data were considered reliable at p ≤0.05. Microscopic examination of abdominal fat revealed mild and moderate residual diffuse lymphoplasmocytic infiltration in addition to edema, fullness and single petechial hemorrhages. Focal dystrophic changes of hepatocytes were determined, in combination with weakly expressed, mainly periportal, less often diffuse intralobular lymphohistiocytic infiltration and with signs of hemodynamic disorders. The signs of blood circulatory disorders, primarily the fullness of the capillary loops of the glomeruli and single weakly expressed lymphoid clusters in the interstitial, mainly perivascular and in the paranephral tissue stand out during microscopy of the kidney tissues of rats who underwent correction of the metabolic syndrome by "Enoant". The analysis of the obtained results allows us to conclude that the use of grape polyphenols in the composition of "Fanocor" inhibits the development of negative structural and morphofunctional changes in the tissues of the heart, liver, kidneys and visceral cellular in the conditions of modeling the metabolic syndrome, and also optimizes the regeneration in these organs. The obtained data give grounds to recommend polyphenolic products of grape processing for inclusion in the complex of treatment of maxillofacial patients with infectious odontogenic inflammatory diseases developed on the base of metabolic syndrome.

S2895 Cytomegalovirus Ileitis: A Rare Cause of Sub-Acute Diarrhea

INTRODUCTION: Cytomegalovirus (CMV) enteritis is a common infection in immunocompromised patients. In the gastrointestinal tract, CMV infections are often seen in the esophagus and colon; only rarely do they involve the small bowel. We present a case of acute CMV pan-ileitis confirmed on histopathology. CASE DESCRIPTION/METHODS: A 77-year-old man with previous history of high-grade muscle-invasive urothelial carcinoma treated with resection, biweekly chemotherapy, and radiation presented with sub-acute non-bloody watery diarrhea up to 10 times per day. Symptoms were not associated with fever, melena, hematochezia or abdominal pain. Initial laboratory values were notable for elevated inflammatory markers and an elevated fecal calprotectin without leukopenia (Table 1). A CT scan of the abdomen and pelvis revealed pan-ileitis. Initial clinical management focused on possible infectious ileitis versus undiagnosed Crohn’s disease. He was empirically treated for bacterial enteritis with ceftriaxone and metronidazole, without improvement after completing a one-week course. Colonoscopy then was performed and showed erythema, edema, and ulceration at the Terminal ileum (TI) (Figure 1). Pathology showed fibrin-inflammatory exudates and lymphoplasmocytic infiltrates in the lamina propria, with mild architectural distortion (Figure 2). Viral immunostains demonstrated CMV inclusion bodies. Due to these results, he then was started on oral valganciclovir and discharged home. Subsequent serum immunoglobulin test results confirmed elevated levels of both CMV IgM and IgG. DISCUSSION: The usual presentation of CMV enteritis includes abdominal pain, vomiting or diarrhea, with only rare reports of ileal perforation. Arriving at this diagnosis can be challenging, especially in the absence of immunosuppression or pathognomonic punched-out ulcerations. CMV enteritis also can mimic both infectious and ischemic colitis. Current guidelines recommend treating active CMV enteritis with antiviral therapy, regardless of whether the patient is immunocompromised. Previous reports have suggested there can be prolonged and persistent infection with lack of spontaneous resolution, even in young immunocompetent individuals. In addition, there is an increased mortality rate in immunosuppressed patients with CMV infection. Thus, patients undergoing biologic or chemotherapy who are diagnosed with CMV enteritis should receive appropriate treatment as soon as possible.Table 1.: WBC: white blood cell count; AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; CRP: C-reactive protein; TB: tubercolosis; IBD: inflammatory bowel diseaseFigure 1.: A. Colonoscopy showing ulcerated mucosa and surrounding erythema in the Terminal Ileum. B. Inflammation characterized by erythema in the Terminal Ileum.Figure 2.: Low power Hematoxylin and eosin shows granulation tissue, inflammation; B,C. higher power hematoxylin and eosin shows and infected endothelial cell with nuclear and cytoplasmic inclusions D. shows positive immune-histochemical staining for CMV.

Clinical and morphological characteristics IgG4-associated retroperitoneal fibrosis

Background : Retroperitoneal fibrosis (RF) is a rare disease with inflammation and fibrosis of the retroperitoneal soft tissues and adjacent organ involvement. At present, a proportion of RF cases are believed to be IgG4-associated. Aim : Clinical and morphological comparison of the IgG4-associated and idiopathic (non-IgG-associated) RF. Materials and methods : The study was based on a comprehensive morphological assessment of surgical and biopsy samples taken from 12 RF patients. In addition to hematoxylin eosin stained specimens, we performed immunohistochemistry (IHC) with determination of absolute CD138 + counts, IgG + and IgG4 + cells in the inflammatory infiltration, as well as IgG4/IgG and IgG4 + /CD138 + ratios. Results : The proportion the IgG4-associated RF was 66.7% (8/12). The majority of IgG4-associated RF patients were men, with the mean age of 54.9 ± 10.3 years. Idiopathic RF was found without any gender imbalance in the younger patients. In all cases of IgG4-associated RF, the adjacent organs were also involved, whereas in those with idiopathic RF the aortic wall was involved in only half of the cases. Morphological specimen investigation in IgG4-associated RF showed signs characteristic for an IgG4-associated disorder, such as advanced lymphoplasmocytic infiltration, storiform fibrosis, and obliterating phlebitis. IgG4 + plasma cells numbers in the infiltrates was at least 25 per high-power field, and the IgG4 + /IgG + and IgG4 + /CD138 + ratios exceeded 50% in all cases. No signs of an IgG4-associated disease were found in idiopathic RF, with significantly lower numbers of IgG + and IgG4 + plasma cells in the infiltrations and the IgG4 + /IgG + ratio below 10%. Conclusion : A big proportion of RF is IgG4-associated, being an intrinsic feature of a systemic autoimmune IgG4-associated disease. The differential diagnosis should be based on the morphological assessment and immunohistochemistry results with obligatory identification of CD138, IgG, and IgG4 expression in the involved tissues. In some cases, it allows for avoidance of an unnecessary surgery. Reliable and accurate diagnosis would determine the subsequent treatment strategy of these patients.

P0204PREVALENCE AND PREDICTIVE FACTORS OF BIOPSY-PROVEN NEPHROPATHY RELATED TO MONOCLONAL GAMMOPATHY

Abstract Background and Aims The prevalence of monoclonal gammopathy (MG) and kidney disease increases with age. When a patient present with both conditions, it is often necessary to perform a kidney biopsy in order to rule out a Monoclonal Immunoglobulin-Related Nephropathy (MIRN) that may require a specific therapy that targets either an overt hematological malignancy or a MG or Renal Significance (MGRS). The aim of our study was to identify factors that predict the presence of MIRN in this setting. Method This retrospective monocentric study included all patients who underwent a kidney biopsy between 2007 and 2018 with concurrent presence of GM, as defined by positive serum immuno-electrophoresis and/or Bence-Jones proteinuria. Results 328 patients were included, representing 11.8% of all kidney biopsies performed in our center during this period. Indication of biopsy was renal failure (eGFR <60ml/min/1.73m) in 77.4% of cases and/or proteinuria (urine protein-to-creatinine ratio >0.5g/g) in 75.9% of them. Median (IQR) serum creatinine was 155 μmol/L (111-233), eGFR 37.5 (22-56) ml/min/1.73m, serum albumin 29.5 (24-35) g/l. Median age was 67 (57/75), the M/F ratio was 198/130, diabetes mellitus was present in 21.3% of cases, hypertension in 53.1%. Kidney biopsy revealed that nephropathy was related to MG in 91/328 patients (27.7%). Myeloma cast nephropathy and AL amyloidosis were the most common histopathological subtypes (36 and 34% respectively), followed by monoclonal immunoglobulin deposition disease (15%) and cryoglobulinemic glomerulonephritis (8%). Patients with MIRN had more severe renal function impairment with median (IQR) serum creatinine of 176 (119-307) vs 149 (108-216) μmol/l (p=0.003) and heavier proteinuria, 3.9 (2.2-8.2) vs 2.0 (0.9-5.2) g/g (p< 0.001), when compared to non-MIRN patients. Hematological malignancy was diagnosed in 83 cases (25,3%) (Multiple Myeloma in 62, non-Hodgkin Lymphoma in 6, Waldenström Macroglobulinemia in 6, Chronic Lymphoid Leukemia in 6, Plasmocytoma in 3). Among them, MIRN was diagnosed in 51 (61%) cases but tumoral lympho-plasmocytic infiltration was observed in 9 (11%) cases. In this subgroup of patients, no laboratory test could predict the presence of a specific nephropathy. Among patients with no hematological malignancy (n=245), MIRN was diagnosed in 40 cases (16%) to confirm MGRS diagnosis. The markers that were most commonly associated with the presence of MGRS were positive Bence-Jones proteinuria (OR 4.7; 95%CI 2.2-10.3; p< 0.001), abnormal serum Free Light Chain (FLC) ratio (OR 4.2; 95%CI 1.7-10.7; p< 0.001), and serum electrophoresis spike >1.5 g/l (OR 5.9; 95%CI 2.6-13.5; p< 0.001). However, none of those markers had sufficient power to formally predict the result of the biopsy, as positive (PPV) or negative (NPV) predictive values were 36/41/45 % and 89/86/88 % respectively. Conclusion Almost one-third of patients with MG and kidney disease referred to our Department have biopsy-proven related nephropathy. Although negativity of Bence-Jones proteinuria and a normal serum FLC ratio are frequently associated with the absence of MGRS, kidney biopsy, beyond its diagnostic and prognostic interest, remains the most discriminating test.

IgG4 hypophysitis: Diagnosis and management

IgG4-related hypophysitis is a rare disease, due to a lymphoplasmocytic IgG4 positive infiltration of the pituitary. Literature data are scarce, even though the description of cases has drastically increased over the last years. The aim of this review is to better characterize the natural history, the diagnosis and the management of IgG4-related hypophysitis, based on a clinical case, an exhaustive Pubmed research, and a reappraisal of the criteria for diagnosis. We will specifically focus on the differences with other etiologies of hypophysitis, in the aim of improving the diagnostic procedures for all the physicians who could have to take care of such patients.

Carcinoma medular de mama. Caracterización de una serie de casos, 2010-2019

IntroductionMedullary carcinoma of the breast is a rare subtype of invasive carcinoma that accounts for about 3-5% of all cases of breast cancer. The aim of this study was to characterize a series of cases with anatomopathological diagnosis of medullary carcinoma of the mother, from Hospital Clínico Quirúrgico Docente Joaquín Albarrán, in the period 2010 to 2019. MethodA retrospective, descriptive and observational study was conducted, in which the biopsy records were reviewed, collecting variables such as age and macroscopic and histological characteristics. ResultsIn the period from 2010 to 2019, the histopathological diagnosis of 9 cases of medullary carcinoma of the breast was made, of which 77.8% were typical medullary carcinoma of the breast and 22.2%, atypical. Only 33.3% of the lesions presented intratumoral necrosis; lymphatic permeation was present in 100% of cases; lymph node metastasis was confirmed in 33.3% of cases; The immunohistochemical study revealed that 88.9% of the tumors did not express hormonal and Her-2 receptors, so they were classified as triple negative or basal molecular subtype. ConclusionFor the histopathological diagnosis of CMM, the presence of lymphoplasmocytic infiltrate is essential, always detecting the intensity and distribution pattern of lymphocytes and plasma cells in relation to the characteristics of tumor cells (individual disposition and characteristics). The triple negative molecular subtype was the most frequent.