Mucosal Plaques Research Articles

CPC07 Lupus comedonicus: a not so common entity

Abstract Lupus comedonicus (LC) is an exceedingly rare variant of chronic cutaneous lupus erythematosus (CCLE), with only 13 reported cases in the literature to date. While its aetiology remains unknown, hallmarks include the presence of comedones on erythematous plaques, particularly in seborrhoeic areas. We report a case of LC involving the scalp, concha bowl and upper back. A 53-year-old female smoker with a 20-pack-year history and previous unprovoked pulmonary embolism presented to dermatology with a 2-year history of alopecia and rash affecting her face and upper back. She was initially reviewed by oral medicine for ulcers, where erythematous buccal mucosal plaques with white striations were seen. The initial biopsy showed a patchy lichenoid inflammatory infiltrate, raising suspicions for lichen planus; however, repeat biopsy highlighted perivascular inflammation and keratin plugging suggestive of lupus. Full skin examination revealed patchy scarring alopecia with perifollicular scale and erythema. Erythematous infiltrated plaques were seen on the face with similar more indurated lesions on the upper back associated with open comedones. The eponymous Shuster sign was observed in the left conchal bowl, with associated follicular occlusion. Laboratory studies all returned within normal limits, including antinuclear antibody titres and complement levels. Differential diagnosis included lupus erythematosus tumidus, discoid lupus erythematosus and LC. Lesional biopsies taken from her back confirmed LC, highlighting lichenoid inflammation involving follicles and interfollicular skin, with superficial and deep perivascular infiltrate. We commenced oral hydroxychloroquine at 200 mg once daily for management, with topical mometasone furoate 0.1% to be used while awaiting its full effect. Smoking cessation has also been advised given the potentially antagonistic effect of smoking with lupus and hydroxychloroquine. Hypotheses of the pathogenesis of LC include the effect of sun exposure. Ultraviolet radiation is known to not only enhance the activity of CCLE but may also contribute to the formation of comedones. Actinic damage alters collagen of normal skin, promoting sebum retention and follicular plugging. Given its infrequency, LC could be mistaken for benign conditions, including acne vulgaris, naevus comedonicus and Favre–Racouchot disease. It is plausible that the small case numbers are due to current underdiagnoses. It is important for dermatologists to be aware of and accurately diagnose LC. Apart from its potentially destructive, scarring complications, especially in untreated and misdiagnosed cases, it is associated with systemic lupus in 30% of cases. Delay in diagnosis and therapeutic management can be associated with significant potential morbidity and even mortality.

ORAL CLINICAL MANIFESTATIONS OF SYPHILIS: CASE SERIES

Syphilis is an infectious disease caused by the transmission of the Treponema pallidum bacterium. When left untreated, its morbidity can result in cardiovascular, bone, and neurological disorders. The diagnosis of syphilis can be a challenge because oral lesions can be multiple and mimic many other conditions. This report aims to describe the variety of oral manifestations and the clinical evolution of syphilis. Three patients presented oral manifestations such as mucosal plaques, ulcers with irregular borders, nodules, and erosion, affecting the tongue, buccal mucosa, and palate. The characteristics of the lesions and the patients’ medical histories led to the diagnostic hypothesis of secondary syphilis. Laboratory treponemal and nontreponemal tests confirmed the diagnosis. There is growing evidence of a reemergence of this sexually transmitted infection, and the incidence of primary and secondary manifestations in the mouth should be reinforced for oral and nonoral health care specialists. Syphilis is an infectious disease caused by the transmission of the Treponema pallidum bacterium. When left untreated, its morbidity can result in cardiovascular, bone, and neurological disorders. The diagnosis of syphilis can be a challenge because oral lesions can be multiple and mimic many other conditions. This report aims to describe the variety of oral manifestations and the clinical evolution of syphilis. Three patients presented oral manifestations such as mucosal plaques, ulcers with irregular borders, nodules, and erosion, affecting the tongue, buccal mucosa, and palate. The characteristics of the lesions and the patients’ medical histories led to the diagnostic hypothesis of secondary syphilis. Laboratory treponemal and nontreponemal tests confirmed the diagnosis. There is growing evidence of a reemergence of this sexually transmitted infection, and the incidence of primary and secondary manifestations in the mouth should be reinforced for oral and nonoral health care specialists.

A case of immune checkpoint inhibitor-related colitis with a distinctive endoscopic finding of colonic pseudolipomatosis

A man in his 70s received anticancer chemotherapy with the anti-programmed cell death protein-ligand 1 antibody atezolizumab for non-small cell lung cancer. Ten days later, he developed diarrhea and skin rash, which were suspected to be due to immune-related adverse events, and was treated with prednisolone for 2weeks. Five weeks after atezolizumab administration, he was admitted to our hospital for Common Terminology Criteria for Adverse Events Grade 3 diarrhea and hematochezia. Sigmoidoscopy revealed a dark red color in the mucosa of the transverse colon and multiple whitish mucosal plaques extending from the transverse colon to the rectum. Biopsy specimens revealed empty vacuoles in the lamina propria with infiltration of numerous inflammatory cells, including CD8+ T cells. Based on the findings of sigmoidoscopy and histology, the diagnosis was immune checkpoint inhibitor-related colitis with colonic pseudolipomatosis. The endoscopic findings and symptoms were markedly improved by prednisolone administration. We herein report the first case of immune checkpoint inhibitor-related colitis with characteristic endoscopic findings of colonic pseudolipomatosis. It is important to perform endoscopy and histological evaluation to determine the differential diagnosis and treatment strategy for patients treated with immune checkpoint inhibitors.

MEDIASTINAL TB PRESENTING AS RIGHT MIDDLE LOBE SYNDROME WITH PIGMENTED AIRWAYS ON BRONCHOSCOPY

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Mediastinal tuberculous lymphadenitis (MTLD) is an uncommon manifestation of tuberculosis (TB). We describe a case of MTLD in an adult with a recent history of pleurisy, presenting as right middle lobe syndrome, found to have black mucosal discoloration on bronchoscopy. CASE PRESENTATION: A 60-year-old Afghan female was evaluated for chronic cough. She previously immigrated from Pakistan, at which time she was evaluated for a pleural effusion and positive tuberculin skin test (20mm). Thoracentesis revealed a lymphocytic effusion, normal glucose, low ADA, and negative AFB. She did not complete an isoniazid course, yet her effusion resolved. Two years later, she presented with 2 months of cough, rare hemoptysis, fatigue, night sweats, and dyspnea. She was frail, nontoxic, with a dry cough and coarse right parasternal breath sounds. CT chest showed calcified hilar and mediastinal lymphadenopathy with right middle lobe atelectasis [Figure 1]. Bronchoscopy revealed black mucosal plaques [Figure 2], with a nodular bronchus intermedius lesion obstructing the middle lobe [Figure 3]. Biopsy showed plasma cells, eosinophils, and basement membrane thickening; no malignancy or granulomas. Bronchoalveolar lavage (BAL) and stains for acid-fast and fungal organisms were all negative. She was started on isoniazid and rifampin, with marked improvement at 1 month; CT chest at 2 months showed increased right middle lobe aeration [Figure 4]. She was diagnosed with culture-negative TB, treated with 9-months of therapy. DISCUSSION: Pleurisy is common in primary TB, and often resolves spontaneously1, but one-third have reactivation2. Lymphadenopathy is characteristic of primary disease, but isolated MTLD is unusual in post-primary TB3. Yield of sputum, BAL, and transbronchial biopsy is low in MTLD due to microorganism burden4. EBUS can aid in diagnosis in 42-85%, and mediastinoscopy is an option if benefit outweighs risk5. In a patient with compatible clinical picture, culture-negative TB may be diagnosed after demonstrating response to therapy6. Black airway pigmentation is nonspecific, seen in malignancy, anthracosis, soot, and infections such as Aspergillus and Mycobacterium tuberculosis7. Mechanism is not fully understood, but may reflect rupture of lymph nodes with pigment-laden macrophages into bronchial mucosa7. Despite treatment, it is often irreversible. CONCLUSIONS: MTLD is uncommon in post-primary TB, and diagnosis is difficult due to atypical imaging findings and low organism burden. When traditional methods for diagnosis fail, procedures such as EBUS may increase diagnostic yield. Black mucosal changes can be suggestive of TB. If clinical and radiographic findings are consistent, culture-negative TB may be diagnosed based on response to antimycobacterial therapy. Reference #1: Jeon D. Tuberculous pleurisy: an update. Tuberc Respir Dis (Seoul). 2014;76(4):153-9. Reference #2: Valdés L, Álvarez D, San José E, et al. Tuberculous Pleurisy: A Study of 254 Patients. Arch Intern Med.1998;158(18):2017–2021. https://doi.org/10.1001/archinte.158.18.2017 Reference #3: Kim J, Jang Y, Kim Yo, et. Al. Mediastinal Tuberculous Lymphadenitis Diagnosed by Endosonographic Fine Needle Aspiration. Korean J Gastroenterol. 2016 Dec 25; 68 (6): 312-316. DISCLOSURES: No relevant relationships by richard blinkhorn, source=Web Response No relevant relationships by Hau Chieng, source=Web Response No relevant relationships by Shannon Murawski, source=Web Response

Seeing Spots: Eosinophilic Abscess as an Endoscopic Marker of Giardiasis

Introduction:Giardia lamblia is recognized as the most common protozoan found in the gastrointestinal tract, with the prevalence up to 60% in developing countries. Though typical symptoms may include diarrhea, abdominal discomfort, nausea, and dyspepsia, these are certainly not ubiquitous. A large retrospective review delineated diarrhea in only 29% of patients and abdominal pain in 71%. Gross upper endoscopic features of Giardiasis are nonspecific, including duodenal ulcers and duodenitis, and may be unremarkable in 75% of cases. Colonoscopic features have rarely been reported. To our knowledge, this case represents the first documentation of eosinophilic microabscesses visualized on colonoscopic examination in association with Giardia lamblia. CASE: A 49-year-old Ethiopian man was evaluated for episodic melena over 6 months. He denied abdominal pain, weight loss, fevers, alcohol or NSAID use. Laboratory testing revealed a hemoglobin of 14.3 g/dL, thrombocytopenia to 83 K/uL and peripheral eosinophilia of 11.1%. On upper endoscopy, a normal esophagus and stomach were visualized, though within the duodenal bulb, edema, inflammation, and an apthous ulcer were identified. Biopsies from the stomach and duodenum noted varied degrees of eosinophilic infiltration in the lamina propria, most prominently in the duodenal bulb, without suggestion of Helicobacter pylori. Colonoscopy revealed multiple subcentimeter white mucosal plaques within the cecum with mild surrounding erythema, as well as 3 small “polyps”. Biopsies from these cecal lesions showed polypoid colonic mucosa with marked patchy eosinophilic infiltration in the lamina propria. Both trichrome staining on duodenal aspirate and stool microscopy revealed moderate Giardia lamblia cysts and trophozoites. The patient was treated with oral metronidazole with resolution of symptoms. DISCUSSION: Screening for Giardia with stool microscopy or stool antigen detection by ELISA can be misguided by false negatives due to irregular parasite shedding. Giardia cysts or trophozoites may be identified in duodenal aspirate or on small bowel biopsy. Visualization of similar mucosal and submucosal white plaques or exudates have been reported in association with other hypereosinophilic disorders such as Eosinophilic Esophagitis. Given our case, visualization of these lesions on colonoscopy may prompt consideration of biopsy and analysis of stool to evaluate for parasitic infections such as Giardia lamblia.1915_A Figure 1. Duodenal Bulb endoscopic findings of edema, erythema, erosions, and superficial ulceration.1915_B Figure 2. Multiple sub-centimeter white mucosal plaques seen in the cecum, and identified throughout the colon.1915_C Figure 3. Cecal biopsy showing polypoid colonic mucosa with marked patchy eosinophilic infiltration in the lamina propria.

Oral Manifestations in the Diagnosis of Secondary Syphilis

A 24-year-old black woman attended the dental clinic with complaints of dentin sensitivity. Extraoral physical examination revealed a diffuse cutaneous rash, of 15 days' evolution, on the face, of widespread distribution, and with hypo- and hyperpigmented skin plaques, desquamative surface, and pruritus. Oroscopy analysis revealed asymptomatic erythematous mucous plaques on a grayish background, bilaterally in the soft palate and lower labial mucosa. The diagnostic hypothesis was secondary syphilis. The patient reported of a mouth ulcer that had healed more than 1 year prior. Venereal Disease Research Laboratory (VDRL) and serology tests for HIV were requested; the patient was referred to the infectology service. High titers (positivity) on the VDRL confirmed the diagnosis, negating the need for a biopsy. Treatment consisted of 3 doses of penicillin. After the first dose, the mucosal plaques disappeared, and the cutaneous rash improved, with complete resolution at treatment end. The patient continued the dental treatment, no signs of recurrence were observed.

Clinical Characteristics and Outcome of Lung Transplant Recipients with Respiratory Isolation of Corynebacterium spp.

Although chronic respiratory disease and immunosuppression are risk factors for Corynebacterium species respiratory infection, data are scarce regarding this disease in lung transplantation. Our aim was to describe the clinical characteristics and outcomes of lung transplant recipients (LTR) with respiratory isolation of Corynebacterium spp. This was a retrospective observational study performed at a referral center in Barcelona, Spain (2014 to 2016). We included all LTR in whom Corynebacterium spp. were isolated in at least one good-quality lower respiratory tract specimen. Overall, 24 of 527 (4.6%) LTR at risk during the study period were included. The main epidemiological, clinical, and microbiological data were analyzed. The most frequently isolated species were C. striatum (11/24), C. pseudodiphtheriticum (3/24), and C. amycolatum (3/24). All 19 (76%) patients who underwent bronchoscopy showed abnormalities, mainly mucosal plaques at the bronchial suture and purulent secretions. Clinical cure was achieved in 8/12 (67%) patients who fulfilled the CDC definition of lower respiratory tract infection (LRTI). To assess the clinical relevance of Corynebacterium spp., only patients with monomicrobial isolation (n = 18) were evaluated. LRTI was diagnosed in 9, and a nonsignificant association was found with a significant number of Corynebacterium sp. CFU/ml (7/9 LRTI versus 2/9 non-LRTI, P = 0.057). Persistent infection was associated with metallic bronchial stent implantation (4/4 versus 2/14, P = 0.005). The isolation of Corynebacterium spp. in respiratory specimens of lung transplant recipients may herald a respiratory tract infection or bronchial suture damage. Bronchial stent implantation is a risk factor for the persistence of Corynebacterium species infection.

PATHOGNOMIC MANIFESTATIONS OF SECONDARY SYPHILIS ON ORAL MUCOSA AND LIPS: CLINICAL CASES

Secondary syphilids on oral mucosa and lips are acute contagious; in addition, they are quite often the only clinical manifestation of the syphilis. Therefore the recognition of oral mucosal syphilids is an important, high-priority task. Purpose. To consider the peculiarities and clinical variants of oral mucosal syphilids, what may occur by usual examinations of patients. Material and methods. We observed 36 patients with secondary syphilis, who have syphilids on the oral mucosa or lips. It is presented 12 characteristic cases. The complex serodiagnostic tests for syphilis and HIV and clinical examination of all patients were maked. Results. The oral mucosal syphilids in hall cases (39-71%; p = 0.05), especially by recidive syphilis, were presented the MILIARY “point-papules” or “streak-papules” which grouped in the form of a “seed-pearls strings and rings”. The photographing is handy for their detection. Mucosal PLAQUES and lenticular papules are “delicate” (non-hard), opaline. They are marked but they accounted for little more of half of mucosal eruptions (50-81%; p = 0.05). Besides they were in ⅓ cases with miliary papules combined. Mucosal plaques are focal arranged or else they closely grouped (phenomenon “pseudo confluence”). Imaginary confluenсe of plaques, which are similar in size but various macerated, is particular specific (“mosaic lesion”). ERYTHEMA is out-lined, deep-red, in the form of “stamped” rounded sports (on the hard palate) or else as erythematous angina (on the molle palate) observed. Erythema were occurred in 13-41% of cases, often with papules were combined. PATHOGNOMIC indications of secondary syphilids are geometry regular form and grouping, rounded and out-lined contours, similarity in size. These peculiarities are attributable to the fact that eruptions are developed in places, where the circulating immune complexes (CIC) were fixated. CIC have bioelectric charge. Therefore, CIC arranged and fixed to a force isolines of natural electrostatic field in the tissue. These isolines have geometry regular form of arc or circle. The mechanism of CIC-fixation can be to describe by biophysical theory DLFO (Deryagin-Landau-Forway-Overbeck). The local conditions for CIC-fixation and for formation of infiltrate (papules) are created by lesions of small arterioles and local blood-stream disorders. Conclusion. Secondary syphilids on the oral mucosa are multiform. The use of photographing is handy for detection of miliary papules, which are often, but barely visible.

Imaging findings associated with nasopharyngeal amyloidosis in an Arabian stallion

SummaryA 3‐year‐old Arabian stallion presented for imaging and further work‐up of nasal discharge and respiratory stridor secondary to nasal amyloidosis. Thickening of the nasal mucosa with heterogeneous attenuation of the affected tissues was identified on CT images. The nasal mucosa, mucosa of the arytenoid cartilages, and regional lymph nodes were hypointense on T2 and T1 MRI images with moderate, patchy contrast enhancement. Biopsy and histopathology of the nasal mucosa, mucosa of the arytenoid cartilages and regional lymph nodes confirmed the original diagnosis of amyloidosis. Six fractions of helical tomotherapy did not provide significant improvement in respiratory effort, and permanent tracheostomy was performed. Haemorrhagic nasal discharge and mucosal plaques in the nasal cavity, pharynx, larynx, and trachea worsened over a 19‐month interim. This paper offers the first description of the CT and MRI findings of nasopharyngeal amyloidosis in a horse, and the first description of the use of helical tomotherapy in an equine patient.

Dental Diseases and Intestinal Dysbiosis Among Children.

The goal of the present study correlates dental hard tissue mineralization, mucosal pathologies in the oral cavity and different degrees of intestinal dysbiosis. the study examined two groups: the study group (Group I) included 229 children and adolescents aged 1-17 (mean age 5±1years) with oral pathologies (caries, acute or chronic candidiasis) and confirmed dysbiosis of varying severity and stages as well. Group II (the Control Group) was composed of 50 patients aged 1 - 16 (mean age 5±1years) with oral pathologies but with no detected changes in gastrointestinal (GI) flora. Dental caries were examined by DMFT-index; the extent of dental hard tissue mineralization by vital staining (2% methylene blue) and cases of oral candidiasis was investigated by taking cultures from mucosal plaques. on the basis of the research outcomes the correlation between the different degrees of GI dysbiosis and dental hard tissue mineralization with pathologic expressions in the oral cavity was found. Group I was divided into two subgroups: in the first subgroup that suffered from mild dysbiosis (I and II degree) moderate dental caries was revealed, whereas in the second subgroup with III and IV degree of dysbiosis-high levels of dental caries was detected. In Group II (no GI flora disturbances), the dental hard tissue demineralization indicator was minimal; in children aged 1-3 years the incidence and prevalence of caries were low and increased with age, reaching higher values during puberty (11-16 years). It may be concluded that dysbiosis of GI microflora influences on a degree of dental hard tissue demineralization, which in turn may predispose to the formation of dental caries.

Acute abdomen in a patient with coeliac disease: a case report and literature review of enteropathy-associated T-cell lymphoma (EATl)

A 71-year-old female with a history of poorly-controlled coeliac disease presented with worsening symptoms of small bowel obstruction over 3 weeks. Jejunal, ileal and mesenteric resections were performed. The patient did not recover after surgery and died 3 weeks later. Patchy mucosal ulcerative plaques were seen, corresponding to transmural infiltration by medium-to-large atypical lymphoid cells positive with CD3 and CD56 but negative for CD5, CD8, CD4 and CD20. Similar atypical cells were identified in all regional lymph nodes, in a predominantly sinusoidal distribution. Remaining small bowel mucosa showed typical histological features of coeliac disease, comprising severe villous atrophy, intraepithelial lymphocytosis (reactive lymphocytes) and crypt hyperplasia. EATL of the small intestine with involvement of mesenteric lymph nodes, occurring in the setting of coeliac disease, was diagnosed. EATL is an uncommon lymphoma of intraepithelial T-lymphocytes mostly occurring in patients with coeliac disease. Ten to twenty percent of cases may occur sporadically without coeliac disease (type II EATL) in which monomorphic, medium-sized cells are present. Type II EATL has a distinctive immunophenotype. Both EATL types have very poor prognosis due to low tumour chemosensitivity and aggressive behaviour. Major postsurgical complications are also common in patients who are nutritionally deficient due to coeliac disease.

Candida esophagitis: Feathery appearance as a new sign on barium esophagogram

The characteristic appearance of Candida esophagitis on barium studies is that of diffuse discrete mucosal plaques, which may become confluent to form 'cobblestone or shaggy' esophagus. Many authors have also reported different radiographic findings such as a foamy appearance in florid esophageal candidiasis in immunocompromised patients. This report discusses a “feathery” appearance seen in barium esophagography of a 74-year-old woman who presented with dysphagia. The barium swallow showed fine out- pouching giving a “feathery” appearance, which is similar to what is described as pseudo-diverticulosis in patients with esophagitis complicating gastro-esophageal reflux disease. A diagnosis of esophagitis presumably due to candidiasis was made. This was confirmed by fungal studies on biopsy specimen following flexible esophagoscopy. Radiologists should be aware of this rare manifestation as a new sign of Candida esophagitis in order to avoid unnecessary delay in diagnosis and treatment.

Gross lesions and histopathological findings after inoculation of Eimeria acervulina, E. maxima and E. tenella in broiler chicks

This experiment was aimed at counting excreted oocysts and evaluating the gross lesions and histopathological changes in broiler chicks infected with Eimeria; E. acervulina (Ea), E. maxima (Em) and E. tenella (Et). Twelve-day-old broiler not infected with Eimeria spp. were used in this experiment. At day 12, the birds in group Ea (n=3), Em (n=3) and Et (n=3) were inoculated with 5 × 10 3 sporulated oocysts of Ea, Em and Et per 1 mL of tap water orally and control chick was injected tap water of equal amount. The prepatent period (PP) for Ea, Em and Et were four, five and six days, respectively. To evaluate the progress of the coccidiosis, post-mortem analysis method and histopathological evaluation were performed on two days after PP of Ea and Et, and three days after PP of Em at two-day intervals on one bird from each group. Intestinal segments (Ea, duodenum and upper intestine; Em, mid intestine; and, Et, cecum) of all chicks were obtained from the autopsied birds. Among pathological changes of coccidiosis, target parts of small intestine and caecal pouches were found mucosal petechiation and white plaques streaks in duodenum. Histopathological evidence showed upper small intestinal villus preserved with different phases of parasite (zygotes, oocysts, macro- and micro-gametocytes) after infection with Ea in broiler chicks. Zygotes in the lamina propria and fusion of middle small intestinal villi in broilers infected with Em and invasion of the caecal crypt of oocysts and granulomatous inflammation of caecal submucosa in broilers infected with Et were found.

Clinical analysis on bile reflux gastritis in children

Objective To compare the clinical symptoms,endoscopic lesions,pathological histological changes,and H.pylori infection between children with bile reflux gastritis (BRG) and non BRG.Methods 287 cases of children with upper gastrointestinal symptoms were diagnosed with gastritis by gastroscopy.They included 58 cases of BRG and 229 cases of non-BRG.The clinical symptoms,endoscopic lesions,pathological histological changes,and H.pylori infection were compared between two groups,respectively.Results Between BRG and non-BRG groups,there werent statistically significant difference in the main clinical symptoms including abdominal pain,anorexia,nausea,and early satiety.Incidence of abdominal distension,vomiting,and hiccups was[84.5％ (49/58) vs 66.8％ (153/229),32.8％ (19/58) vs 17.9％ (41/229),and 29.3％ (17/58) vs 16.6％ (38/229)],respectively,with statistical significance (x2 =6.93,6.18,4.83,P ＜0.05).There weren(t) statistically significant difference in endoscopic lesions congestion,edema,and mucosal plaques between two groups.Incidence of endoscopic gastric erosions and bleeding of two groups was [37.9％ (22/58) vs 22.7％ (52/229),20.7％ (12/58) vs 10.0％ (23/ 229)],respectively; and BRG group was statistically higher than non-BRG group(x2 =5.60,4.90,P ＜ 0.05).For micronodular change,there were 13 cases (22.4％) in BRG group and 86 cases (37.6％) in Non-BRG group,and Non-BRG group was statistically higher than BRG group(x2 =4.69,P ＜ 0.05).For histopathological changes including epithelial cell degeneration,hyperplasia and lamina propria lymphocyte and neutrophil infiltration,there wasnt statistically significant difference between BRG and non-BRG groups.Incidence about pit extension and mucosal vascular expansion of two groups was [10.34％ (6/58) vs 3.1％ (7/229) and 31.0 ％ (18/58) vs 18.3 ％ (42/229)],respectively ; and BRG group was significantly higher than non-BRG group(x2 =5.97,4.51,P ＜ 0.05).There were 7 cases (12.1％) in BRG group and 55 cases (24.0％) about lamina propria lymphoid follicles,and Non-BRG group was significantly higher than BRG group (x2 =3.90,P ＜0.05).H.pylori positive rates were[22.41％ (13/58),and 40.17％ (92/ 229)],respectively.BRG group and non-BRG group were found statistically significant (x2 =6.29,P ＜0.05).Conclusions BRG children with the characteristic symptoms were abdominal distension,vomiting,and hiccup inverse.Endoscopic characteristic performance was gastric erosions,bleeding spots in antral mucosa changes apparently.Mucosal vascular expansion and pit extension may prompt gastric in children with duodenogastric reflux.H.pylori positive rates of those gastric in children with bile reflux were relatively low.The clinical features could help early diagnosis BRG and guide clinical treatment to improve the cure rate. Key words: Bile reflux; Gastritis/etiology; Child

Oral pemphigus vegetans: A case report

Pemphigus is a rare vesiculobullous autoimmune disease that exhibits blistering of the skin and oral cavity. It is caused by autoantibodies directed against antigens on the surface of keratinocytes. All forms of pemphigus are associated with the presence of circulating and skin-fixed autoantibodies. Pemphigus vegetans is a rare clinical variant of pemphigus vulgaris and comprises up to 5 percent of all pemphigus cases. In the following we present the oral presentation of pemphigus vegetans. We describe a 33-year-old man who was referred to our clinic complaining about mouth sores, tooth pain, and multiple pustules. During clinical exam we were able to recognize multiple pustules, ulcerated areas on the gingiva, and whitish mucosal plaques. Clinical, histopathological, and direct immunofluorescence findings were compatible with pemphigus vegetans.

Hyper-IgE syndrome: dental implications

Hyper-IgE syndrome (HIES) is a rare multisystem disorder with both immunologic and nonimmunological features. It is characterized by extremely elevated IgE serum levels, eczema, and recurrent skin and pulmonary infections. Dental anomalies are often included, such as retention of deciduous teeth together with ectopic eruption or noneruption of permanent teeth. Severe susceptibility to caries and mycotic infections, insufficient transversal diameter of the palate, mucosal plaques, and fissures typically located on the tongue and on the palate are often present. The aim of this study was to review the literature and to report a 6-year observation of 6 patients with HIES (aged 8-39 years) with focus on their oral problems and the treatment provided. The importance of the role of the dentist both in early diagnosis of this syndrome and in monitoring oral conditions was stressed. The dentist can prevent infective complications and intercept the development of malocclusion with a reduction of the need for complex treatment.

Hereditary mucoepithelial dysplasia: unique histopathological findings in skin lesions

Hereditary mucoepithelial dysplasia (HMD) is a rare, autosomal dominantly inherited, multisystem disease thought to be caused by abnormalities in desmosomes and gap junctions. HMD affects the skin, mucosae, hair, eyes and lungs. Nearly all patients clinically display the triad of non-scarring alopecia, well-demarcated mucosal erythema and erythematous intertriginous plaques. Although histopathological findings of mucous membrane epithelium have been well characterized, only three reports have described histopathologic findings in the skin. We report a case with unique histopathological findings not previously reported in HMD.

Sociodemographic Characteristics and Clinical Associations Among Children Diagnosed With Eosinophilic Esophagitis in Hawaii

racial disparities exist in the clinical presentation or endoscopic appearance of pediatric patients (age 15 eosinophils/HPF). Methods: Retrospective examination of pediatric patients with >15 eosinophils/HPF on esophageal biopsy from 2000-2007 at Temple University Hospital in Philadelphia, PA. Data was gathered from a pathology database searching key word “eosinophils”. The slides were reviewed by a single GI pathologist. Using Temple Hospital's medical record system, we recorded patients' demographics features, presenting symptoms, and endoscopy findings. Statistics were performed using Fisher's Exact Test. Results: Our database identified 34 pediatric patients (62.5% Caucasian (C), 12% African-American, 6% Hispanic) with >15 eos/HPF. Clinical data was found on 32 patients (62.5% C; 81% male). The average age of the Caucasian patients was 8.9 years (range 1-17 years) which was similar to the non-Caucasians average age 7.8 years (range 1-16 years). Patients residence: 47% Philadelphia city limits, 47% Philadelphia suburbs, and 6% New Jersey. 73% in the city of Philadelphia were non-Caucasian (NC). As shown in figure 1, a variety of complaints were seen in C, whereas NC showed a higher percentage of reflux (67%; p=0.14). Endoscopic findings also differed between C and NC as seen in figure 2. The findings of a normal endoscopy, esophagitis, and linear furrowing were more common in NC (33%, 33%, 50%) compared to C (20%, 15%, 35%) (p= 0.43, p= 0.38, p= 0.47)). On the other hand, mucosal plaques were significantly more frequent in C (50%) vs NC (8.3%) (p=0.023). Rings and strictures were not seen in either group. Conclusion: We observed racial differences in the clinical presentation and endoscopic appearance of EoE among pediatric patients. While Caucasians present with a variety of GERD or dysphagia symptoms, non-Caucasian patients presented primarily with GERD symptoms. Caucasian patients had a much higher frequency of mucosal plaques on endoscopy, but other findings did not differ significantly between ethnic groups.

GENITAL HERPESVIRUS IN BOTTLENOSE DOLPHINS (TURSIOPS TRUNCATUS): CULTIVATION, EPIDEMIOLOGY, AND ASSOCIATED PATHOLOGY

We studied the pathology, epidemiology, and clinical significance of genital herpesvirus infection in a zoo collection of bottlenose dolphins (Tursiops truncatus). Samples from the genital mucosa of male (n=21) and female (n=15) dolphins were tested by nested polymerase chain reaction (PCR) targeting the DNA polymerase of herpesvirus. Herpesvirus infection was significantly associated with the occurrence of mucosal plaques on penis (n=3) or vulva (n=4). Biopsies from a penile plaque showed epithelial hyperplasia by histology, contained herpesvirus-like particles by electron microscopy, and tested positive for herpesvirus by PCR. Herpesvirus was successfully cultivated from penile plaque samples and identified as a member of the Gammaherpesvirinae by DNA sequencing and phylogenetic analysis. We used the newly cultivated bottlenose dolphin herpesvirus (TTHV) to develop a direct enzyme-linked immunosorbent assay for anti-TTHV antibodies in banked sera of these dolphins. The percentage of positive samples was higher in adults (20/21, 95%) than in juveniles (7/15, 47%). Seroconversion occurred around the age of onset of sexual behavior. Although herpesvirus infection has been associated with abortion, perinatal mortality, and urogenital neoplasia in other species, we found no evidence of herpesvirus infection by PCR in tissues from six cases of abortion and perinatal mortality, and no diagnoses of urogenital tumors in 24 bottlenose dolphins from this zoo collection that died since 1990. Together, we here report the first successful cultivation from bottlenose dolphins of a herpesvirus that probably causes benign genital plaques, is endemic in this group of dolphins, and is likely transmitted by sexual contact.

Clinical analysis and endoscopic findings of early esophageal cancer

Objective To research the characteristics of early esophageal cancer's endoscopy and its clini-cal diagnosis. Methods Retrospective analyze the clinical symptoms and endoscopy performance of the 24 cases of early esophageal cancer which were confirmed by opemtion. Results Unaided eye observing of 24 cases of early e-acphageal cancer:diameter of pathological changes within 1.0 cm,there are four cases of the surface rough,turbidity,vascular fuzzy texture, congestive mucosa, small pieces of rotten to the core, around the realm of clear, easy bleeding by touch of three cases. Mucosa focal irregular plaquelike erosion or superficial helcosis of five cases Mucosa mild uplift,smooth surface or erosion, with slightly different colors of 10 cases ( including one case of pelypoid change) Mucosa fo-cal wormhole-like change, a slight hollow, moss-covered, rubeosis or bleeding lesions after water rinse, irregular and clear borders of two cases, pathology report: one case of small cell carcinoma,one case of adenocarcinoma (cardia),High-level intraepithelial neoplasia transformation nine cases, one case of poorly differentiated adenocarcinoma, 12 ca-ses of squamous cell carcinoma. Conculsion Endoscopic early esophageal cancer for the mainfeatures of the mucous membrane color changes, mucosal thickening, transparency and mucosal vascular network st ructure changes, and mu-cosal rough, nodules, plaques, erosion and uplift superficial, shallow depression and other patterns chang, GeneraUe-sions were confined or isolated like chang, irregular, and the mucous membrane around the borderclear. Clinicalofte misdiagnosed, missed diagnosis, early diagnosis to have significant value. Key words: Esophageal neoplasms; Gastroscopy