Nodular Enlargement Research Articles

Palisaded Encapsulated Neuroma (PEN): A Case Report

A growth or tumor of nerve is neuroma. Localised and circumscribed neuromas are termed as true neoplasm, as per James W. Patterson's quotation. Further, Palisaded encapsulated Neuroma (PEN) is a distinctive cutaneous nodular lesion often in the head, neck and face regions and are benign. They have schwannian and axonal components. A 30 year old male presented to surgical OPD with nodular enlargement in the scar behind the ear. Grossly these are usually pear shaped or bulb like dermal nodule. Microscopy showed peripheral circumscription for nodules of axonal and schwannian cells with predominance of fibroblastic component. Various references support above findings. And therefore, we arrived to a conclusion of this being PEN within scar tissue, as regards to clinical and histopathlogic peculiarities both gross and microscopic. DOI: http://dx.doi.org/10.3126/jucms.v1i1.8420 Journal of Universal College of Medical Sciences Vol.1(1) 2013: 28-32

A misleading cause of pseudo-thymic tumor in ectopic Cushing’s syndrome

A 27-year-old man was referred with typical features of severe Cushing's syndrome. A bilateral adrenalectomy was performed. Three months later, a triangular nodular mediastinal enlargement, evocative of a right anterior thymic tumor, was discovered. Thymectomy was undertaken. Histological examination revealed diffuse thymic hyperplasia with negative immunostaining for adrenocorticotropic hormone. Five years later, a right endobronchial tumor corresponding to a carcinoid tumor was removed.

Ligneous gingivitis: a case report

Ligneous gingivitis, also known as destructive membranous periodontal disease is a rare periodontal condition. While first case was published by Frimodt-Moller at 1973, ligneous conjunctivitis was first described in 1847 by Bouisson. It is characterized by nodular gingival enlargement with ulcerations. Usually conjunctival and gingival lesions were observed together and have same histopathological changes. A 32 month-old female patient with ligneous conjunctivitis, was referred to Gaziantep University, Faculty of Dentistry, Department of Periodontology clinic with the diagnosis of spread gingival enlargement at the mandible and maxilla. These gingival enlargements were painless, hyperemic, nodular, and woody-like and covered by pseudo membrane. Radiographic evaluation showed normal alveolar bone and no attachment loss. Hematological analyses showed an increase in white blood cells, and increase in lymphocytes but decrease in neutrophils. As far as we know this is the youngest case reporting ligneous gingivitis after Frimodt-Mollers' case. Although most of the case reports focused on histopathological change and level of plasminogen in these patients, up to now exact information about pathogenesis of ligneous gingivitis and conjunctivitis is not available in the literature. Question of the researchers about how to manage and effectively treat this disease remains unclear.

Destructive Membranous Periodontal Disease (Ligneous Gingivitis): A Literature Review

Destructive membranous periodontal disease, or ligneous gingivitis, is a rare condition involving nodular gingival enlargement with ulceration and periodontal tissue destruction. This review gives a brief account of the cases reported in the literature. An effort is also made to define the periodontal disease caused by plasminogen deficiency with a view to its potential inclusion in the classification of periodontal diseases. A MEDLINE/PubMed and manual search was conducted to find papers describing ≥1 case of ligneous disease involving the oral mucosa. We identified 23 articles reporting 35 cases. For each patient, we analyzed various characteristics, including age, sex, age of onset, oral symptoms, histologic features, plasminogen levels (functional activity, plasma antigen), genetic features, treatment, and results of treatment during the reported follow-up. Ligneous gingivitis is a rare periodontal disorder closely associated with ligneous conjunctivitis and plasminogen deficiency. Its diagnosis may be supported by the finding of genetic mutations responsible for the condition. Research is focusing on the future development of an effective therapy capable of arresting the destructive evolution of the disease. Additional studies, investigating features such as probing depth and attachment loss, are needed for the appropriate classification of this periodontal disease.

Primary adenocarcinoma of the epididymis: the therapeutic role of retroperitoneal lymphadenectomy

This case report describes a rare case of adenocarcinoma of the epididymis and the role of locoregional surgery in the therapeutic algorithm. We report a case of primary adenocarcinoma of the epididymis in a 61-year-old man who was primarily examined for nodular enlargement of the head of the epididymis. Retroperitoneal lymphadenectomy which the patient underwent after radical orchiectomy revealed lymph node metastases, subsequently he received adjuvant chemotherapy. The patient remains free of disease for 20 months after surgery. Primary adenocarcinoma of epididymis is a rare finding with an unfavorable prognosis in higher stages as it responds poorly to radiotherapy and chemotherapy. Our case report confirms the importance of retroperitoneal lymphadenectomy in patients with local or locoregional disease. It may be curative even in case of proven lymphadenopathy and should be performed in all patients without distant metastases.

Bilateral Multiple Extraocular Muscle Metastasis from Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) rarely metastasizes to the extra ocular muscles (EOMs). We present a case of bilateral metastasis of HCC to the EOMs and focus on the magnetic resonance imaging (MRI) features. Orbital MRI revealed nodular enlargement of bilateral multiple EOMs, with isointensity on T1-weighted images and heterogeneous, intermediate-to-high signal intensity on T2-weighted images, and showed mild-to-significant heterogeneous contrast enhancement with gadolinium. Physicians should be aware of this rare cause of EOM enlargement, understand the radiologic characteristics of EOM metastasis, and thus make appropriate treatment strategy.

Trans-urethral ultrasound (TUUS) imaging for visualization and analysis of the prostate and associated tissues.

The incidence of prostate disease is high. However, accurate assessment of pathological conditions is still difficult. Although CT, MRI, and TRUS imaging methods provide useful information, each has specific drawbacks. Our work examines the potential and utility of 3D trans-urethral ultrasound (TUUS) for improved imaging of the prostate. Four normal canines were examined with TUUS. The catheter was placed in the urethra and used to image the prostate, rectum, bladder, ureter, neuro-vascular bundles, arteries, and surrounding tissue. 2D and 3D datasets were acquired and digitized. The 2D data provides useful visualization of the tissue. The clinician was also able to watch urine enter the bladder and perform a digital rectal exam in real-time. 3D data visualization required torodial reconstruction. The algorithm was optimized to provide very fast 3D reconstructions of the prostate. Segmentation of the data proved challenging, but 3D visualization, including volume rendered data and surface rendered data, were well accepted by clinicians. Clinicians and researchers determined a number of potential applications of these new techniques, including: prostate cancer diagnosis and staging, assessment of Benign Nodular Enlargement, assessment of physiologic function of the bladder, evaluation of morphologic properties of the prostate, and image guided biopsy and therapy.

Intrathyroidal ectopic thymic tissue may mimic thyroid cancer: a case report

Ectopic intrathyroidal thymus tissue that may be present as a thyroid nodule is rarely reported. We present a case of a 4-year-old boy with a solitary thyroid nodule. Real-time thyroid ultrasound showed a calcified nodule in the right lobe. Complete blood count, serum calcitonin, and thyroglobulin concentration were normal and antithyroid antibodies were negative. Fine-needle aspiration (FNA) biopsy was revealed as inadequate for cytological examination. During his follow-up, nodular enlargement was found, and the patient was subjected to surgical total excision of the right lobe of the thyroid gland. Pathological examination showed an ectopic intrathyroidal thymus tissue. In childhood, ectopic intrathyroidal thymus tissue can present as an enlarging microcalcified thyroid nodule that may mimic thyroid cancer and may grow during follow-up.

Novel pathogenic role of fibrin as revealed by a case study on ligneous gingivitis

Purpose of the researchLigneous gingivitis is a rare disease characterized by nodular gingival enlargement secondary to fibrin deposits induced by micro-injury in the gingiva, which disorder results from plasminogen (PLG) deficiency. Although none have investigated the association of wound healing factors with ligneous gingivitis. In this study, in addition to a histopathologic examination of ligneous gingivitis in a case of type I PLG deficiency, we further present data showing the effect of wound healing factors in association with fibrin in vitro to clarify the pathobiology of ligneous gingivitis in PLG-deficient patients. Principle resultsImmunohistochemical analysis revealed that transforming growth factor (TGF)-β1, connective tissue growth factor/CCN2 (CCN2), and endothelin-1 (ET-1) had accumulated in the extracellular matrix around the epithelial and fibroblastic cells near the fibrin deposition. Consistent with these results, fibrin and TGF-β1 synergistically up-regulated CCN2 and ET-1 gene expression in human dermal fibroblasts. Major conclusionsFibrin plays a vicious role in ligneous gingivitis pathobiology by up-regulating CCN2 and ET-1 expression through the TGF-β signaling pathway.

Cytologic, flow cytometry, and molecular assessment of lymphoid infiltrate in fine‐needle cytology samples of Hashimoto thyroiditis

The thyroidal lymphoid infiltrate (TLI) in Hashimoto thyroiditis (HT) represents the substrate from which thyroid lymphoma may arise. The objective of the current study was to classify the TLI in HT by comparing the cytologic features with flow cytometry (FC) data and evaluating the kappa/lambda light chain ratio and its molecular assessment. Fine-needle aspiration cytology (FNAC) was performed in 34 patients with HT with nodular or diffuse palpable enlargement of the gland. Two or 3 passes were performed to prepare traditional smears, FC, and immunophenotyping, and RNAlater suspensions for molecular assessment. FC was performed using the following antibodies: CD3, CD5, CD4, CD8, CD10, CD19, and kappa and lambda light chains. In 4 cases, high molecular weight DNA was extracted and used for polymerase chain reaction (PCR) to amplify the variable diversity joining region of the heavy chain immunoglobulin (Ig) genes (IgH). Statistical analysis was performed to evaluate possible associations between clinical ultrasound presentation, cytologic pattern, and TLI phenotype. Light chain expression was evaluated as the percentage of the expressing cells (</=20% and >20%) and as the kappa/lambda ratio. Smears were classified as "lymphocytic," "lymph node-like," or "mixed." FC demonstrated T cells (CD3 positive [+], CD5+) in all cases, and T cells and B cell (CD19+, CD10+/-) lymphocytes in 22 cases. Light chains were expressed in 30 cases (in <20% of the gated cells in 13 cases and in >20% of the gated cells in 17 cases). Five cases demonstrated small kappa/lambda ratio imbalances and PCR analysis demonstrated diffuse bands in the gel and Gaussian curves at the heteroduplex. Statistical analysis indicated significant associations between the "lymphocytic" pattern and T-cell phenotype and between the "lymph node-like" pattern and B-cell phenotype. A significant association also was observed between light chain restriction and low light chain expression (P < .005). The cytologic pattern of TLI in HT is quite representative of the clinical presentation and phenotypic cell type. Small light chain imbalances are not sustained by heavy chain Ig gene (IgH) rearrangements. FNA coupled with FC may contribute to making the distinction between florid TLI and non-Hodgkin lymphoma.

Relapse of leprosy presenting as nodular lymph node swelling

Lymphadenopathy is known to be associated with lepromatous leprosy and has also been observed as a feature of type-2 lepra reaction. However, nodular lymph node enlargement is not commonly reported in leprosy patients or as a feature of relapse. We herewith are presenting a case of bacteriological relapse in a patient of lepromatous leprosy treated 22 years before till smear negativity with WHO multidrug therapy (MDT) multibacillary type (MB). She presented with prominent nodular swelling of the cervical group of lymph nodes along with generalized lymphadenopathy, which was mistakenly treated as tubercular lymphadenopathy. A diagnosis of late bacteriological relapse of lepromatous leprosy presenting with prominent lymphadenopathy and ENL was made after relevant investigations. The patient was started on treatment with WHO MDT MB (daily dapsone and clofazimine and monthly rifampicin) and thalidomide (200 mg/day). Nerve pain regressed within 2 weeks of therapy. The lymph nodal swelling regressed within 3 months of starting treatment.

Tophaceous Pseudogout of the Femorotibial Joint in a Painted Turtle (Chrysemys picta)

A 5-year-old painted turtle (Chrysemys picta) presented with a 1cm nodular enlargement of the right femorotibial joint. The right leg was amputated, because the nodule continued to grow and motor problems appeared. The cut surface of the nodule was yellowish white, and had a colloidal to chalky gross appearance. Microscopically, a multinodular foreign-body granuloma was observed around the joint capsule. Morphological and histochemical examination showed that the foreign body consisted of calcium pyrophosphate. Histological findings revealed that the articular cartilage was mainly involved in the pathological onset of the disease, and was therefore diagnosed as tophaceous pseudogout. This disease is generic in elderly people, but is rare in animals. Also, there are only three reports in reptiles.

Successful treatment of ligneous gingivitis with warfarin

Ligneous gingivitis is a rare condition characterized by inflammation and nodular gingival enlargement secondary to fibrin deposits in the gingival that results from plasminogen deficiency. Several therapeutic approaches have been used with limited success. We report a case of a patient with homozygous plasminogen deficiency and ligneous gingivitis that was initially refractory to local care and systemic antibiotics, but later improved with the addition of warfarin.

Vasopressin-Responsive ACTH-Independent Macronodular Adrenal Hyperplasia Causing Cushing's Syndrome

ACTH-independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of endogenous Cushing's syndrome (CS). The diagnosis is suggested by bilateral adrenal nodular enlargement on conventional imaging and the demonstration of ACTH-independent hypercortisolism. Cortisol secretion in AIMAH can be regulated by the aberrant adrenal expression of receptors for gastric inhibitory polypeptide, vasopressin, catecholamines, luteinizing hormone/human chorionic gonadotropin and serotonin. We report on a 47-year-old man with CS due to AIMAH. The cortisol levels were increased after vasopressin stimulation, suggesting aberrant expression of vaso-pressin receptor in the adrenal glands. Total adrenalectomy is considered a standard therapy for AIMAH.

Hashimoto′s thyroiditis - A Malaysian perspective

This study was undertaken to analyze the fine needle aspiration (FNA) cytologic, functional and immunologic features in Hashimoto's thyroiditis (HT) with special reference to ethnicity in Malaysian patients. 88 cases of HT retrieved from the archives of the cytology laboratory were reviewed. Ethnic, clinical, cytologic, biochemical, and immunologic features were correlated. HT <http://correlated.HT> was more common in Indian patients (57%). 33% of HT cases presented with nodular thyroid enlargement (47.5% were Chinese). 57.5% were euthyroid and 35% hypothyroid. Thyroglobulin antibody (TG Ab) and thyroid peroxidase antibody (TPO Ab) (tested in 29/88 cases) were elevated in 83% and 93% cases respectively. Review of cytologic smears showed Hurthle cells in 56% cases, high lymphoid to epithelial ratio in 38%, lymphoid follicles in 67%, follicular cell infiltration by lymphoid cells in 69% and lymphohistiocytic clusters in 40%. Giant cells and/or granulomas were present in 45% and plasma cells and/or immunoblasts in 40% of cases. 17% showed neutrophils and/or eosinophils infiltrating follicular epithelial cells. Follow up FNA of eight cases showed appearance of a diagnostic cytologic pattern in all and changes in clinical presentation in four. Hashimoto's thyroiditis was more common among Indian women with nodular presentation seen more often in Chinese. Hurthle cell change, lymphoid follicles and follicular cell infiltration by lymphoid cells, considered histologic hallmarks of HT, were seen less frequently. 17% cases showed infiltration of follicular cells by neutrophils and eosinophils, a hitherto undescribed feature in HT. Follow up cytology was helpful in monitoring progression of disease and arriving at a definitive diagnosis.

Esclerose sistêmica e sarcoidose

Os autores descrevem o caso de uma paciente com esclerose sistemica (ES) - forma limitada - com comprometimento pulmonar tipo fibrose intersticial. Apos sete anos sem acompanhamento, foram identificados gânglios mediastinais e esplenomegalia. A biopsia de linfonodos mostrou granuloma nao caseoso sugestivo de sarcoidose. Estamos mostrando, neste caso, a associacao de ES e sarcoidose, para chamar a atencao para esse fato e enfatizar que a sarcoidose deve ser lembrada no diagnostico diferencial das complicacoes pulmonares da esclerodermia.

Primary hyperparathyroidism in 29 dogs: diagnosis, treatment, outcome and associated renal failure

To review the records of 29 dogs diagnosed with primary hyperparathyroidism and see if any factors correlate with renal failure. Dogs were selected retrospectively from case files from the QVSH and the QMH. The majority of dogs were middle-aged and four were keeshonds. The primary presenting complaints were polyuria and polydipsia. All dogs had an elevated total and ionised plasma calcium concentration. Plasma phosphate concentrations were variable. Ultrasonography of the parathyroid gland revealed nodular enlargement which was found to correlate well with surgical findings. The majority of dogs underwent surgical parathyroidectomy. Five cases were treated by ultrasound-guided chemical ablation of the parathyroid gland, of which only two cases showed a partial response. Three dogs were euthanased within a week of presentation. Seven other dogs had renal failure diagnosed either at presentation or up to six months after parathyroidectomy. The development of renal failure was correlated with total calcium concentration but did not correlate with any other factor, including the calcium phosphate product. Thirteen treated dogs were known to be alive at the time of writing, which was six months to 3.5 years after parathyroidectomy. Primary hyperparathyroidism cases with high total calcium were more likely to develop renal failure in this group of dogs; however, the calcium phosphate product did not seem to be a useful predictor. Ultrasound-guided chemical ablation seemed to have limited advantage over surgery.

Genome-wide linkage analysis reveals evidence for four new susceptibility loci for familial euthyroid goiter.

Euthyroid goiter is characterized by diffuse or nodular enlargement of the thyroid gland. Iodine deficiency and cigarette smoking have been identified as important environmental factors. However, family and twin pair studies suggest a strong genetic predisposition. Therefore, we performed the first extended genome-wide scan to identify susceptibility loci that predispose for euthyroid goiter using 450 microsatellite markers in 18 extended Danish, German, and Slovakian families. Parametric and nonparametric multipoint linkage analyses were performed. The highest nonparametric LOD scores were obtained for chromosomes 2q and 3p with values of 2.54 at D2S1363 and 2.25 at D3S3038, respectively. Assuming heterogeneity and dominant inheritance, heterogeneity LOD scores (HLOD) of 2.71 and 1.94 were calculated for 2q and 3p, respectively. Furthermore, nonparametric LOD scores of 1.87 (HLOD 1.39) at D7S1808 on 7q and 1.79 (HLOD 1.80) at D8S264 on 8p were obtained. Haplotyping of families contributing to the linkage signals revealed four families compatible with a putative locus on 3p and one family each showing strict cosegregation with the loci on 2q, 7q, and 8p. The four novel candidate loci corroborate the assumed heterogeneity in the etiology of euthyroid familial goiter. For the first time, a more prevalent putative locus, present in 20% of the families investigated, was identified.

Metastatic gastroesophageal junction adenocarcinoma to the extraocular muscles

Objective To present one definitive and one probable case of gastroesophageal adenocarcinoma metastases to the extraocular muscles. Design Two observational case reports. Methods Two interventional case reports with clinical pathologic correlation and review of the literature. Vanderbilt University Institutional Review Board approval was obtained for this report. Main outcome measures We analyzed the presenting symptoms, visual acuity, motility, and external examination. Results Computed tomography showed nodular enlargement of an isolated rectus muscle. Histopathologic examination confirmed the diagnosis of metastatic gastrointestinal carcinoma in one case. The orbital neoplasm contained signet ring cells, classically seen in gastrointestinal malignancy. Conclusions Metastasis from gastrointestinal carcinoma should be considered in the differential diagnosis of a patient presenting with diplopia or visual loss, particularly with a recent history of gastrointestinal malignancy.

Symptomatic spinal dissemination of malignant astrocytoma.

Symptomatic spinal dissemination of malignant astrocytoma is rarely found except at autopsy. This study evaluated the clinical incidence and characteristics of spinal dissemination and the effect on outcome. Patients treated for primary malignant astrocytoma, including 33 with anaplastic astrocytoma and 35 with glioblastoma, at our department between 1997 and 1999 were followed up until April 30, 2001. Head magnetic resonance (MR) imaging of all patients was obtained every 2-3 months. Signs and symptoms of leptomeningeal spread were checked at monthly outpatient examinations. Spinal MR imaging was performed if any symptoms indicating spinal dissemination were found. Median survival times of patients with anaplastic astrocytoma and glioblastoma were 40.5 and 16.0 months, respectively. Seventeen patients (25%) developed intracranial dissemination and 15 of these died. Six patients (8.8%), one with anaplastic astrocytoma and five with glioblastoma, developed spinal dissemination. All patients with spinal dissemination also had intracranial dissemination. Five of the six patients died, despite systemic radiochemotherapy in four patients. All patients died of extensive whole brain and spinal dissemination or nodular mass enlargement at the upper cervical cord, not of local massive tumor progression. Symptomatic spinal dissemination of malignant astrocytoma is not so rare, and is the cause of death. The relatively high incidence of symptomatic leptomeningeal dissemination must be considered in the treatment of malignant astrocytomas.