Moderate Lymphocytic Infiltration Research Articles

A case of chronic spontaneous urticaria with wheals lasting for more than a week.

Urticaria is characterized by the development of wheals which usually disappear within a day, and are not present beyond a few days. A 58-year-old man began to develop edematous, partially ring-shaped erythematous lesions accompanied by severe body itching without any particular cause, approximately 2 months before his first visit to our hospital. Each rash emerged as being about 5 mm in diameter, gradually enlarging over several days, and disappeared in up to 10 days. Despite oral treatment with several antihistamines and 10 mg of prednisolone, there was no improvement. Most eruptions disappeared without a trace, but the erythema that appeared on the palms left desquamation. The patient had a history of shellfish allergy, but otherwise no atopic diseases. Drug eruption was ruled out due to a lack of regular taking other medications. Histopathological findings of the skin lesions showed moderate lymphocytic and few eosinophilic infiltrates with edema, but no evidence of vasculitis. Despite the concomitant use of two second-generation antihistamines and montelukast, the rash did not improve. The symptoms began to improve following oral intake of 1.5 mg of betamethasone, which was tapered off with the addition of 150 mg of cyclosporin. The use of all medications was stopped at 4 months from the first visit without recurrence. Wheals of chronic spontaneous urticaria may last for longer than a week without apparent histopathological findings of vasculitis.

Pure intertubular seminoma (PITS) of the testis: A multi-institutional cohort of a rare growth pattern of seminoma

Pure intertubular seminoma (PITS) of the testis is described as the presence of seminoma cells within the interstitium of testis without any evidence of diffuse growth pattern or mass lesion of classical seminoma. These tumors are clinically and grossly inconspicuous and are diagnosed incidentally or during investigations for testicular pain, infertility or other symptoms. Rarely metastasis is the first presentation. Microscopic identification can be difficult and poses a diagnostic challenge in the absence of a mass lesion. Seminomas with exclusive intertubular growth patterns were gathered in an international cohort. Diagnoses were confirmed by fellowship-trained or specialized urologic pathologists. Cases with the presence of a classical diffuse or nested pattern of seminoma or any other germ cell tumor component were excluded. The patient's age, tumor characteristics and additional clinicopathologic features were recorded and analyzed. 15 patients of pure intertubular seminoma (PITS) were collated. The mean age of presentation was 29 years. Patients presented with variable symptoms, including undescended testis (26%, n = 4/15), testicular heaviness/pain (20%, n = 3/15) infertility (20%, n = 3/15) and metastasis (6%, n = 1/15); presentation was unknown in 4 patients. Of note, none of the patients presented because of testicular mass. Serum markers were within normal limits in most patients (93%, n = 14/15) with available data. No tumors were identified macroscopically; however, an ill-defined, grey-white, firm area was noted in one orchiectomy specimen. Microscopically, tumor cells were seen in intertubular spaces as dispersed individual cells or small clusters. Tumor cells were round to polygonal with large nuclei and prominent nucleoli. Mild to moderate lymphocytic infiltrates were seen admixed with tumor cells in 40% (n = 6/15) of the tumors. GCNIS was present in association with most PITS (73%, n = 11/15). Tubular atrophy with thickening of the basement membrane and Leydig cell hyperplasia was observed in one tumor. Thirty-three percent (n = 5/15) of the tumors showed pagetoid involvement of rete testis, including the tumor with metastasis. All tumors showed the classical immunohistochemical profile of seminoma, with PLAP, c-KIT, OCT3/4, D2-40 and SALL4 positivity. PITS can be clinically & pathologically inconspicuous, difficult to stage and liable to be misdiagnosed especially if presented with metastasis. Despite the inconspicuousness, PITS may represent an aggressive growth pattern of seminoma with the propensity for rete testis invasion.

POST-TRAUMATIC BRACHIAL ARTERY PSEUDOANEURYSM (CLINICAL CASE)

We present a clinical case of treatment of pseudoaneurysm of the right brachial artery. The cause of the pseudoaneurysm was a gunshot wound to the right shoulder. An aneurysmectomy, endarterectomy, and autovenous prosthetic repair of the right brachial artery were performed. Histological examination revealed thrombotic masses, a fragment of the vessel wall with fibroblast proliferation, hemorrhages, focal hemosiderosis, and moderate lymphocytic infiltration. 6 months after surgery, limb function was completely restored. Autovenous prosthetic repair of a section of the brachial artery with a pseudoaneurysm due to a gunshot wound is an effective surgical method of treatment and restoration of blood flow.

Fowl Aviadenovirus (FAdV-11) as the causative agent of a vertical outbreak of inclusion body hepatitis in commercial broiler breeders in Brazil

Inclusion body hepatitis (IBH), caused by Fowl Aviadenovirus (FAdV), is a significant disease affecting chickens worldwide. FAdV-11 associated with IBH was identified in 9-day-old commercial broiler breeders in Brazil. The chicks exhibited a sudden increase in daily mortality, accompanied by nonspecific clinical signs, in one house on the farm. The cumulative mortality rate reached 11.13 % by 15 days of age. Macroscopically, the liver was markedly enlarged and pale red with a distinct lobular pattern. Histologically, the liver showed mild to severe multifocal coalescent vacuolar degeneration and necrosis, with hepatocyte nuclei diffusely enlarged and containing large basophilic inclusion bodies. Additionally, the heart exhibited a diffuse, moderate infiltration of lymphocytes and plasma cells, with focal thrombosis in the epicardium. FAdV was detected in liver samples using specific primers for the hexon gene (52 K-fw and 52 K-rv) in a polymerase chain reaction (PCR) assay. Sequencing of the hypervariable region of this gene (Hex L1) for phylogenetic analysis revealed FAdV-D species serotype 11. To our knowledge, this is the first report of FAdV-D serotype 11 as the causative agent of a vertical outbreak of inclusion body hepatitis in broiler breeders in Brazil.

The Impact of Two Types of Mycoplasma gallisepticum Vaccines on Broiler Chicken Respiratory System.

This study aimed to evaluate the effect of vaccinating 1-day-old broilerchicks with two commercial vaccines such as live chronic respiratorydisease F strain (CRDF) and killed Mycoplasma gallisepticum (MG)vaccines on the respiratory system. For this purpose, one-day-old broilerchicks (n=120) were randomly divided into four groups; (n=30 birdseach). All groups were treated as followed: G1(CRDF): chicks werevaccinated with live CRDF vaccine (eye drop one drop 0.03ml/dose/10 5 ),G2 (killed MG): chicks were vaccinated with killed MG vaccine injectionwith 0.3ml s.c /3 x10 10 C.F.U/ml), G3: chicks were combined vaccinatedwith killed MG and CRDF live vaccines G4: served as controlunvaccinated group. The vaccination was performed at one day old in G1(CRDF), G2(killed MG), and G3 (killed MG and live CRDF). Thehistopathological changes of the trachea and air sacs were examined andevaluated at 35 days old. The results of histopathological examination ofair sacs in the G1(CRDF) revealed various mild epithelial hyperplasiawith papillary-like growth, subepithelial lymphocytic infiltration, in G2
 (killed MG), showed hyperplastic epithelial surfaces with moderatelymphocytic infiltration mainly around congestion capillaries. While G3(killed MG and CRDF) showed focal epithelial hyperplasia (villus-like),and perivascular lymphocytic aggregation in laminar C.T. Whereas G4(control) showed normal structures without any histopathological lesions.In the trachea the histopathological changes in G1(CRDF) showed focallymphocytic aggregation with a follicle-like appearance, another sectionshowed focal epithelial and cilia loss with goblet cell hypertrophy of theadjacent gland. G2 (killed MG) showed partial loss of thin mucosa withmild and desquamation lymphocytic infiltration in lamina propria,G3(killed MG and CRDF) showed diffuse mononuclear cells (MNCs)infiltration in tracheal mucous and submucosa with evidence of cysticdilution of adjacent gland together G4 control tracheal tissue showednormal structure without any lesions. Finally, it was determined thatvaccination with killed MG and live CRDF vaccines caused a moreobvious immune reaction (lymphoproliferative infiltration) in therespiratory system, including the trachea and air sac than the vaccinationwith combined killed and live vaccines, while the live Mycoplasmavaccines individually caused minor damage, particularly in the trachea.

Morphological and immunohistochemical analysis of tumor-infiltrating lymphocytes, M2 macrophages, BCL 6 and SOX10 in the tumor microenvironment of nodular cutaneous melanoma

Introduction. Cutaneous melanoma is one of the most aggressive malignant tumors, and its nodular form with vertical growth is characterized by unfavorable prognosis. However, in the recent years due to advances in basic oncology, a breakthrough in drug therapy of this pathology was made. To a great extent, it is linked to implementation of new therapy with checkpoint inhibitors. The best and longest response rates of cutaneous melanoma to this treatment were achieved compared to other oncological diseases. This fact can be explained by immunogenicity of cutaneous melanoma, high mutational load, as well as features of its tumor microenvironment, where in most cases high infiltration by immunocompetent cell is observed. However, immune cells vary by their composition and functions. Some of them can even promote tumor growth. Therefore, study of cell composition, degree and distribution of immune infiltration in the tumor can help identify potential factors of favorable and unfavorable prognosis for cutaneous melanoma which is important in clinical practice.Aim. To determine the frequency of CD3+-, CD4+-, CD8+-T-lymphocytes, CD163, BCL6 and SOX10 expression in patients with primary nodular cutaneous melanoma, as well as correlation of these markers with each other and standard morphological parameters for this non-epithelial malignant tumor.Materials and methods. In the study, the expression frequency of CD3+-, CD4+-, CD8+-T-lymphocytes, CD163, BCL6 and SOX10 in the postoperative material of 20 patients with true primary nodular cutaneous melanoma was measured using immunohistological analysis. The correlation of these markers with each other and standard morphological parameters was determined.Results. In most cases of nodular cutaneous melanoma, moderate and marked lymphocytic (immune) infiltration (grade II–III) was observed with no correlation with Breslow tumor thickness. Study of the ratio between CD4-positive T helpers and CD8-positive cytotoxic T lymphocytes in the tumor microenvironment showed that the number of the latter increased the higher was the degree of immune infiltrate. Markedness of macrophage infiltration directly correlated with markedness of lymphocytic infiltration. BCL6 expression in lymphocytes was observed in all cases of infiltration.Conclusion. Immune infiltrate in nodular cutaneous melanoma is a multicomponent, dynamic microenvironment containing both antitumor and tumor-promoting components with balance shifting to one or other side. Their qualitative, quantitative and, possibly, topographic ratios in the primary lesion of cutaneous melanoma affect the effectiveness of drugs and disease prognosis. Knowledge on the predominance of components negatively affecting tumor growth in the primary lesion can help an oncologist in selection of correct treatment tactics and disease observation.

Features Of Morphological Changes in the Pancreas

Objective to study the morphological and functional disorders of the pancreas and blood vessels of the lower limb of rats with experimental diabetes mellitus. Material and methods. The object of the study were 90 white rats at the age of 4-6 months. The morphological changes of the pancreas and the walls of blood vessels of the lower limb in experimental diabetes mellitus. Model of experimental diabetes reproduced by single intraperitoneal administration of streptozotocin Wistar rats at a dose of 60 mg / kg. Results. Comparison of the mass of bodies of rat control and experimental group showed that during the experiment, the experimental group of rats had plenty in development compared to the control group by 1.7 times. In all the experiments in terms of pancreatic islets was observed moderate lymphocytic infiltration. Morphological examination of the vessels in different time postnatal ontogenesis demonstrated that compared with the control group in the form of changes in the delay of progression and formation of individual components vascular wall. Destructive changes in the arterial wall marked us all experimental animals from the early days after the experiment. Conclusion. The results indicate that the type 1 diabetes the pancreas causes changes and limbs.

Nitazoxanide, Ivermectin, and Artemether effects against cryptosporidiosis in diabetic mice: parasitological, histopathological, and chemical studies.

Human cryptosporidiosis is one of the most significant causes of water borne epidemics of diarrhea worldwide. It is extremely important in immunocompromised hosts and malnourished children as it could cause severe life-threatening diarrhea. Despite the global burden of the disease, there are only few available therapies against cryptosporidiosis. Diabetes mellitus is a common metabolic disorder that impair both the innate and adaptive immune responses of the patient. This study aimed to test the effect of Nitazoxanide, Ivermectin, and Artemether against cryptosporidiosis in diabetic mice. Sixty white albino mice were categorized into 6 groups; 10 mice each: GI: normal non-infected non-treated (healthy- control), GII-GVI (diabetic groups), GII: non-infected non treated (diabetic control), GIII: infected non treated (infected control), GIV: infected and treated with Nitazoxanide (NTZ), GV: infected and treated with Ivermectin (IVC), GVI: infected and treated with Artemether (ART). Parasitological, histopathological, and chemical examinations were done to evaluate the effect of NTZ, IVC, and ART against cryptosporidiosis in diabetic mice. Parasitological examination revealed maximum reduction of oocyst shedding in GVI, while histopathological examination showed the least pathologic changes in GV with mild vascular wall fibrosis and moderate lymphocytic infiltration of islets of Langerhans. Measurement of blood glucose level showed the best results with GIV. Nitazoxanide is effective against cryptosporidiosis in diabetic patients with minimal hyperglycemia, Artemether is especially effective in reducing the oocyst shedding in stool, whereas Ivermectin is associated with the least pathological changes in pancreatic islets of Langerhans.Graphical abstract

The Anti-Rheumatic Drug, Leflunomide, Induces Nephrotoxicity in Mice via Upregulation of TGFβ-Mediated p53/Smad2/3 Signaling.

Recent studies indicated renal toxicity and interstitial nephritis in patients receiving leflunomide (LEFN), but the exact mechanism is still unknown. The transforming growth factor β (TGFβ)/p53/Smad2/3 pathway crucially mediates renal fibrosis. We aimed to assess the nephrotoxic effect of LEFN in mice and the possible role of TGFβ-stimulated p53/SMAD2/3 signaling. The study design involved distributing sixty male albino mice into four groups: (i) vehicle-treated mice, (ii) LEFN (2.5 mg/kg), (iii) LEFN (5 mg/kg), and (iv) LEFN (10 mg/kg). The drug was given orally every 48 h and continued for 8 weeks. Blood samples were then taken from mice for the determination of kidney function parameters. Right kidneys were used for histopathologic staining and immunohistochemistry, whereas left kidneys were frozen and used for Western blot analysis of the target proteins, p-p53 and Smad2/3. Results indicated that chronic administration of LEFN in mice resulted in a four- and nine-fold increase in serum urea and creatinine levels, respectively. Kidney specimens stained with hematoxylin and eosin or periodic acid–Schiff showed significant histopathological manifestations, such as cellular irregularity, interstitial congestion, and moderate lymphocytic inflammatory infiltrate in mice treated with LEFN. Western blotting indicated upregulation of the p-p53/Smad2/3 proteins. LEFN, especially in the highest dose (10 mg/kg), produced prominent nephrotoxicity in mice. This toxicity is mediated through stimulating fibrotic changes through TGFβ-stimulated p53/Smad2/3 signaling and induction of glomerular and tubular apoptosis. An improved understanding of LEFN-induced nephrotoxicity would have great implications in the prediction, prevention, and management of leflunomide-treated rheumatic patients, and may warrant further clinical studies for following up these toxidromes.

Histopathologic and Molecular Characterization of Uterine Leiomyoma-like Inflammatory Myofibroblastic Tumor: Comparison to Molecular Subtypes of Uterine Leiomyoma.

Uterine leiomyoma (UL) is a common benign neoplasm which can sometimes be difficult to differentiate from the uterine inflammatory myofibroblastic tumor (IMT) based on morphology alone. IMT is a myofibroblastic/fibroblastic neoplasm which has typically been considered to be rare in the uterus. Its clinical behavior is usually indolent although aggressive variants exist. The majority of IMTs harbor genomic rearrangement of anaplastic lymphoma kinase ( ALK ), while ALK fusion has not been thus far detected in ULs. We analyzed 2263 ULs of which 9 (0.4%) had tyrosine-kinase activation. Seven of the samples were ALK immunopositive: 6 had an ALK fusion gene and 1 overexpressed an ALK transcript skipping exons 2 to 3, Moreover, 1 sample had a RET , and 1 a PDGFRB fusion gene. While no recurrent somatic mutations were found, 1 patient had an ALK germline mutation. Seven tumors showed leiomyoma-like morphology, 1 tumor had slightly loose, and 1 fibrous growth pattern. Six tumors had mild to moderate lymphocyte infiltration, while no immune cell infiltration was detected in 3 cases. None of the tumors showed aggressive behavior. Except for strong ALK positivity (7/9 tumors) the protein expression profile of the tumors was identical to ULs and distinct from other mesenchymal uterine tumors. In gene expression level, these tumors and the known UL subclasses did not separate perfectly. However, vitamin C metabolism and epithelial-mesenchymal transition pathways were uniquely enriched in these lesions. The overall similarity of the analyzed tumors to UL raises the question whether an UL diagnosis would be more proper for a subset of uterine IMTs.

Evaluation of Efficacy and Potential Complications of the Plant-Based Nanoparticles Hemostat Powder on Controlling Hemorrhage in Rat Models of Liver Injury: An Experimental Study

BackgroundLiver surgery is associated with an increased risk of bleeding, which required time management. Several hemostatic agents have been developed. However, plant-based materials have shown some superiority in hemostasis time and lower complications. The aim of our study was to prepare plant-based topical hemostatic Nanoparticles from the rosaceous family as a novel hemostatic agent.Material and Methods Twenty male Wistar rats were randomly divided into two study groups. All the rats were sedated and underwent incision in the anterior lobe of the liver. In the control group, the incision site was firstly compressed with a manual compression with dry gauze for 2 minutes and then repeated every 30 seconds until hemostasis was achieved. In the intervention group, homeostatic material was applied on the site of the incision, and clotting time was recorded. Paired Samples Test was used to compare the mean hemo­stasis times in Nanoparticles and control groups. P <0.05 considered significant.ResultsHemostasis was successfully achieved in both groups. Hemostasis time in Nanoparticles and control groups were 6.7±1.33 and 183±26.26 seconds, respectively and their differences were significant (P < 0.001). The histopathology assessment showed mild increases in vascularity, fibrosis, and polymorph nuclear neutrophils (PMN) infiltration was seen in one case. Mild to moderate lymphocyte infiltration was detected in 2 cases. ConclusionThe produced plant-based Nanoparticles could significantly reduce the hemostasis time compared to the control group.

Chronic liver disease not a significant comorbid condition for COVID-19

To explore the role of chronic liver disease (CLD) in COVID-19. A total of 1439 consecutively hospitalized patients with COVID-19 from one large medical center in the United States from March 16, 2020 to April 23, 2020 were retrospectively identified. Clinical characteristics and outcomes were compared between patients with and without CLD. Postmortem examination of liver in 8 critically ill COVID-19 patients was performed. There was no significant difference in the incidence of CLD between critical and non-critical groups (4.1% vs 2.9%, p = 0.259), or COVID-19 related liver injury between patients with and without CLD (65.7% vs 49.7%, p = 0.065). Postmortem examination of liver demonstrated mild liver injury associated central vein outflow obstruction and minimal to moderate portal lymphocytic infiltrate without evidence of CLD. Patients with CLD were not associated with a higher risk of liver injury or critical/fatal outcomes. CLD was not a significant comorbid condition for COVID-19.

Peripheral blood levels of tumor-infiltrating lymphocytes (TILs) and circulating tumor cells (CTCs) in patients with colorectal cancer.

e15510 Background: Tumor is a structure where malignant cells interact, among others, with cells of the adaptive and innate immune systems largely determining the tumor microenvironment. The role of TILs in the disease prognosis has been shown. The amount of CTCs is one of the factors that significantly affect the risk and rate of metastasis. The purpose of the study was to assess an association between TILs and CTCs in the peripheral blood of patients with various stages of colorectal cancer (CRC). Methods: The study included 299 patients (aged 42-86 years, mean age 64.2±1.7) with stage II-IV CRC T1-4N0-2M0-1. TILs were identified in tumor material after standard histological processing. Lymphocytes were counted per 100 epithelial cells in 5 fields of view at a magnification of x400; the result was expressed as a percentage ( &lt; 5% weak, 5-30% moderate, &gt;30% strong). The numbers of CTCs were measured in the peripheral blood using the Veridex CellSearch system (Janssen), taking into account the expression of epithelial cell adhesion markers EpCAM, cytokeratins 8,18,19 and absence of the CD45 expression. The blood sample was evaluated according to the following criteria: 0 CTCs, 1-3 CTCs, and more than 3 CTCs. Statistical analysis of results was performed in the Statistica 13.0 program (StatSoftInc., USA). Results: Weak lymphocytic infiltration was detected in 32.8%, moderate - in 48.1%, strong - in 19.1% of cases. CTCs were detected in 62.9% cases (in 188 of 299 patients). The percentages of patients with 1-3 CTCs and with &gt;3 CTCs were equal - 50% (94 of 188). CTCs were not registered in 37.1% cases (111 of 299). The absence of CTCs was noted equally often in moderate and strong lymphocytic infiltration – 43.7% and 43.8%. The presence of tumor cells in the peripheral blood was most often detected in weak lymphocytic infiltration, being 1.4 times more frequent than in moderate and strong infiltration (76.5% vs. 56.3% and 56.2%) (p = 0.019, c2= 11.890). Conclusions: The study demonstrated a significant relationship between the level of CTCs and the intensity of lymphocytic infiltration in the tumor (p≤0.05), which can be used as a new prognostic approach.

High BRAF variant allele frequencies are associated with distinct pathological features and responsiveness to target therapy in melanoma patients

BackgroundBRAF mutant melanoma patients are commonly treated with anti-BRAF therapeutic strategies. However, many factors, including the percentage of BRAF-mutated cells, may contribute to the great variability in patient outcomes.Patients and methodsThe BRAF variant allele frequency (VAF; defined as the percentage of mutated alleles) of primary and secondary melanoma lesions, obtained from 327 patients with different disease stages, was assessed by pyrosequencing. The BRAF mutation rate and VAF were then correlated with melanoma pathological features and patients’ clinical characteristics. Kaplan–Meier curves were used to study the correlations between BRAF VAF, overall survival (OS), and progression-free survival (PFS) in a subset of 62 patients treated by anti-BRAF/anti-MEK therapy after metastatic progression.ResultsA highly heterogeneous BRAF VAF was identified (3%-90%). Besides being correlated with age, a higher BRAF VAF level was related to moderate lymphocytic infiltration (P = 0.017), to melanoma thickness according to Clark levels, (level V versus III, P = 0.004; level V versus IV, P = 0.04), to lymph node metastases rather than cutaneous (P = 0.04) or visceral (P = 0.03) secondary lesions. In particular, a BRAF VAF >25% was significantly associated with a favorable outcome in patients treated with the combination of anti-BRAF/anti-MEK drug (OS P = 0.04; PFS P = 0.019), retaining a significant value as an independent factor for the OS and the PFS in the multivariate analysis (P = 0.014 and P = 0.003, respectively).ConclusionThese results definitively support the role of the BRAF VAF as a potential prognostic and predictive biomarker in melanoma patients in the context of BRAF inhibition.

Ultrastructure of the Anisakid nematode, Raphidascaroides sp (Nematoda: Anisakidae) from the freshwater fish Rhinogobius ocellatus (Fowler, 1937) with attendant histopathological alterations in Lekki Lagoon, Lagos, Nigeria

The objective of this study is to report the parasitic infections in the gobiid fish with histopathogical changes and the SEM description of the recovered parasites for possible unreported morphological details and for the purpose of control measures in the fish species. Fishes were procured, dissected and examined parasitologically. The nematode, Raphidascaroides sp was the only recovered parasite from the intestine of the gobiid fish. Fixation of the parasites was done in 2.5% glutaldehyde and were post fixed in 1% Osmium tetraoxide, sputter coated and examined with the Scanning Electron Microscope. The infected tissues were also fixed in Bouins fluid.The overall prevalence of infections was 70.7%. Male specimens of the fish species were more susceptible to infections (71.4%) than the female specimens (66.6.) The Raphidascaroides sp. ultrastructure revealed three lips with dentigerous ridges.The two ventrolateral lips measures 68.6 and 69.7 µm while the third lip has a length of 55.1 µm with corresponding breadth of 66.0 µm, 40.5 µm and 59.3 µm respectively. The histopathological alterations in the fish species revealed goblet cell hyperplasia and moderate lymphocytic infiltration of the lamina propria.The dominant and only parasite recovered from the fish host is Raphidascaroides sp, an anisakid nematode whose pathological consequences is mild owing to lack of holdfast organs in nematodes. The ultrastructural description of the parasites is the first report in Nigeria. There is a conclusion that there may be similar food and feeding habits of the fish, Rhinogobius ocellatus with Gymnarchus niloticus with a report of the same parasites in its intestinal mucosa.

Detection of Carp pox virus (CyHV-1) from koi (Cyprinus carpio L.) in Iran; clinico-pathological and molecular characterization

Cyprinid herpesvirus 1 (CyHV-1) is the causative agent of carp pox characterized by epidermal papillomas in common carp and other cyprinids. In this study, we identified CyHV-1 in koi (Cyprinus carpio) from Iran in 2017 and 2019, showing clinical signs of the carp pox disease. Histopathology showed severe epidermal hyperplasia and the absence of club and goblet cells. Degenerative changes, including spongiosis and single-cell necrosis, were also observed. Keratinocyte dysplasia and a moderate lymphocytic infiltration were observed within the epidermis. PCR of the extracted DNA from skin lesions of affected koi from both outbreaks showed CyHV-1 specific TK amplicons, with high sequence identity (above 99%) among themselves and with other CyHV-1 isolates belong to Cluster I, as well as show 97% similarity to Cluster II isolates. To the best of our knowledge, this is the first report of Carp pox disease (CyHV-1) of koi in Iran and the Middle East.

\u201cBlack box warning\u201d rash with entecavir - case report

BackgroundHepatitis B infection is a significant worldwide health issue, predispose to the development of liver cirrhosis and hepatocellular carcinoma. Entecavir is a potent oral antiviral agent of high genetic barrier for the treatment of chronic hepatitis B infection. Cutaneous adverse reaction associated with entecavir has rarely been reported in literature. As our knowledge, this case was the first case reported on entecavir induced lichenoid drug eruption.Case presentation55 year old gentlemen presented with generalised pruritic erythematous rash on trunk and extremities. Six weeks prior to his consultation, antiviral agent entecavir was commenced for his chronic hepatitis B infection. Skin biopsy revealed acanthosis and focal lymphocytes with moderate perivascular lymphocyte infiltration. Skin condition recovered completely after caesation of offending drug and short course of oral corticosteroids.ConclusionThis case highlight the awareness of clinicians on the spectrum of cutaneous drug reaction related to entecavir therapy.

LICHENOID MUCOSITIS DIAGNOSED IN CENTER OF REFERENCE IN ORAL LESIONS: A CASE REPORT

This study reports a case of a 56-year-old melanoderm woman who lives in the rural area of Nordestina, Brazil. The patient reported to have anemia and the use of ferrous sulfate and simvastatin. Also, the patient was a cigarette smoker for 17 years. During the intraoral examination nondetachable white lesions were observed in the right and left superior alveolar ridge, extending to vestibular, retromolar, and palatal areas. Nearby the second superior molar, the lesions showed irregular shape, contour, and well-defined limits. The clinical hypothesis was leukoplakia. After an incisional biopsy in the right inferior retromolar area, the histopathologic examination revealed an epithelium exhibiting hyperplasia, acanthosis, and hydropic degeneration of basal cells leading to the disappearance of the basal layer. The lamina propria exhibited moderate lymphocytic inflammatory infiltrate, in a juxtaposition, compatible with lichenoid mucositis. The patient has been in follow-up to identify the etiology of the lesions.

English

Amblygonocarpus andongenesis is being used as antipsychotic. Hence, it may portend high risk of toxicosis. In view of this, phytochemical screening and toxicological effects of aqueous stem bark extract of the plant was studied in wistar albino rats. Qualitative screening of the stem bark extract revealed the presence of alkaloid, hydrolysable tannin, saponin, glycoside, cardiac glycoside, saponin glycoside and anthraquinone glycoside. Quantitative screening revealed 4.04% alkaloid, 4.94% saponin and 14.38% true tannins. Subchronic dose (900 mg/kg) caused increased and decreased significant levels of basophils and eosinophils (P&lt;0.05) respectively. Serum biochemistry revealed increased alkaline phosphatase level (P&lt;0.05). A mild periportal and perivascular lymphocytic infiltrations of the liver and moderate focal lymphocytic infiltration of the menninges (focal nonsupurative meningitis) which are suggestive of mild toxicity of A. andongensis were observed. Hence, the plant is toxic at dose level of 900 mg/kg body weight when administered for a period of 28 days. Key words: Toxicity; Amblygonocarpus andongensis, phytochemicals, stem bark, brain, liver, rat. &nbsp

SAT-243 Lymphocytic Hypophysitis Mimicking Pituitary Apoplexy in a 27-Year-Old Woman

Introduction:Lymphocytic hypophysitis is an uncommon inflammatory disorder of the pituitary gland. Peripartum women are most often affected, but it can be seen in a wide range of patients. Patients can present with pituitary dysfunction or mass effect symptoms, making it difficult to differentiate from a pituitary adenoma. Pituitary apoplexy is an acute syndrome due to hemorrhage into the pituitary gland causing headache, visual deficits, and hypoadrenalism. We present a case of a woman with a pituitary mass presenting with symptoms mimicking pituitary apoplexy, in whom surgical pathology later revealed lymphocytic hypophysitis without evidence of hemorrhage.Clinical Case:A 27-year-old non-pregnant female presented with severe headaches, nausea, vomiting, and diplopia for four days. A presumed pituitary macroadenoma was diagnosed two years previously during a workup for irregular menses. An emergency evaluation with a CT angiogram of the head showed enhancement at the superior aspect of and surrounding the pituitary gland. MRI of the pituitary revealed an enhancing 17 x 17 mm sellar and suprasellar mass compressing the optic chiasm, without evidence of the normal pituitary posterior bright spot. Visual field testing was normal. She was referred for transsphenoidal resection of the pituitary mass due to persistent headaches, optic chiasm impingement, and suspicion of pituitary apoplexy. Intraoperatively, there was no evidence of hemorrhage. Central diabetes insipidus and hypothyroidism developed in the post-operative period. She was discharged on hydrocortisone replacement therapy (20 mg in the morning, 10 mg in the afternoon). An outpatient random cortisol level of 1.2 mcg/dL (reference: 6.7 - 22.6 mcg/dL) while off hydrocortisone for twenty-four hours confirmed hypocortisolism. Surgical pathology showed moderate lymphocytic infiltrate and focal germinal centers in the adenohypophysis consistent with lymphocytic hypophysitis.Conclusion:Although lymphocytic hypophysitis is well-described in the literature, its association with symptoms suggesting pituitary apoplexy has been reported only rarely. This atypical case shows that lymphocytic hypophysitis can present with acute symptoms mimicking pituitary apoplexy. The case highlights the difficulties in recognizing lymphocytic hypophysitis prior to surgery and emphasizes the need to consider the diagnosis in patients presenting with pituitary masses and/or symptoms of pituitary apoplexy.