Pathological Lesions Research Articles

The Emaciation Disease: The Possibility of Non-Pathogenic Occurrence in Olive Flounder (Paralichthys olivaceus)

Emaciation disease has directly affected the production of olive flounder—a major aquaculture species in Korea—since the 2000s. Various myxosporeans have been reported as its causative agents. In this study, we investigated the recent resurgence of emaciation on Jeju Island, considering not only myxosporean infections but also potential environmental factors. Unlike previous studies that have primarily attributed the causes of emaciation disease to infections by myxosporeans, this research aimed to determine whether pathogen infection is indeed the sole cause of emaciation disease through molecular and histopathological analyses. Molecular biological and histopathological analyses of aquaculture and laboratory samples revealed that gross pathology lesions of emaciation can occur in the absence of pathogens, as well as in environments with myxosporean infections. These findings suggest that emaciation disease can be exacerbated by certain environmental factors in addition to myxosporeans. Future research should focus on detailed experimental designs to identify the specific environmental conditions contributing to the severity of this disease.

Highly Pathogenic Avian Influenza A(H5N1) Virus Infection in Cats, South Korea, 2023.

In July 2023, cases of highly pathogenic avian influenza (HPAI) were reported at 2 shelters for stray cats in Seoul, South Korea. The cause of infection was suspected to be improperly sterilized raw food made from domestic duck meat, which was manufactured in South Korea. All viruses isolated from cats at the shelters and from the raw food belonged to HPAI A(H5N1) clade 2.3.4.4b. The gene constellation of all viruses was most similar to that of viruses isolated in Korea in November 2022. Of note, the viruses isolated from infected cats harbored mutations E627K or D701N in polymerase basic 2, which are indicative of adaptation to mammals. Postmortem examination revealed systemic pathologic lesions and the presence of widespread virus in different tissues. Thus, consumption of raw duck meat contaminated with HPAI virus likely caused systemic symptoms and death in cats, indicating the introduction of mammal-adapted mutations of the virus.

Bilateral Parotid Gland Oncocytoma Mimicking Oropharyngeal Cancer Metastasis: A Case Report from a Radiation Oncologist's Perspective.

Parotid oncocytomas typically present as benign, unilateral, slow-growing, painless, and solitary masses that are histologically firm and multilobulated. They are often misdiagnosed as pleomorphic adenomas, hemangiomas, or other forms of oncocytosis. However, in our case, the parotid oncocytomas initially mimicked bilateral parotid gland metastasis of advanced oropharyngeal cancer. Here, we present a case of oropharyngeal cancer with bilateral parotid oncocytomas treated with chemoradiotherapy (CCRT). We report the case of a 74-year-old man with a sore throat, neck pain, right earache, oropharyngeal cancer, and bilateral parotid gland oncocytoma. Head and neck computed tomography and magnetic resonance imaging (MRI) showed soft-tissue swelling in the right tonsillar fossa and several enlarged level II neck lymph nodes. MRI revealed enhancing masses in both parotid glands, initially suspected to be metastatic lymph nodes. A biopsy of the right palatine tonsil confirmed squamous cell carcinoma with human papilloma virus-16 positivity. A positron emission tomography scan was performed, and biopsy-proven malignant lesions were observed in the right tonsillar region with metastatic lymph nodes in the right and left neck. Focal hypermetabolism was observed in the parotid glands, suspected to be pathological lesions such as metastatic intra-parotid lymph node or Warthin's tumor. An ultrasonography-guided biopsy of the left parotid gland confirmed an oncocytoma. Based on these results, the patient was scheduled for CCRT. After pathological confirmation of parotid oncocytoma, CCRT was administered, excluding the parotid glands within the radiotherapy field. This is a case of bilateral parotid gland oncocytoma mimicking oropharyngeal cancer.

Senolytic treatment diminishes microglia and decreases severity of experimental autoimmune encephalomyelitis

BackgroundThe role of senescence in disease contexts is complex, however there is considerable evidence that depletion of senescent cells improves outcomes in a variety of contexts particularly related to aging, cognition, and neurodegeneration. Much research has shown previously that inflammation can promote cellular senescence. Microglia are a central nervous system innate immune cell that undergo senescence with aging and during neurodegeneration. The contribution of senescent microglia to multiple sclerosis, an inflammatory neurodegenerative disease, is not clear, but microglia are strongly implicated in chronic active lesion pathology, tissue injury, and disease progression. Drugs that could specifically eliminate dysregulated microglia in multiple sclerosis are therefore of great interest to the field.ResultsA single-cell analysis of brain tissue from mice subjected to experimental autoimmune encephalomyelitis (EAE), a mouse model of CNS inflammation that models aspects of multiple sclerosis (MS), identified microglia with a strong transcriptional signature of senescence including the presence of BCL2-family gene transcripts. Microglia expressing Bcl2l1 had higher expression of pro-inflammatory and senescence associated genes than their Bcl2l1 negative counterparts in EAE, suggesting they may exacerbate inflammation. Notably, in human single-nucleus sequencing from MS, BCL2L1 positive microglia were enriched in lesions with active inflammatory pathology, and likewise demonstrated increased expression of immune genes suggesting they may be proinflammatory and contribute to disease processes in chronic active lesions. Employing a small molecule BCL2-family inhibitor, Navitoclax (ABT-263), significantly reduced the presence of microglia and macrophages in the EAE spinal cord, suggesting that these cells can be targeted by senolytic treatment. ABT-263 treatment had a profound effect on EAE mice: decreasing motor symptom severity, improving visual acuity, promoting neuronal survival, and decreasing white matter inflammation.ConclusionThese results support the hypothesis that microglia and macrophages exhibit transcriptional features of cellular senescence in EAE and MS, and that microglia expressing Bcl2l1 demonstrate a proinflammatory signature that may exacerbate inflammation resulting in negative outcomes in neuroinflammatory disease. Depleting microglia and macrophages using a senolytic results in robust improvement in EAE disease severity, including across measures of neurodegeneration, inflammation, and demyelination, and may therefore represent a novel strategy to address disease progression in multiple sclerosis.

Inhibition of an Alzheimer's disease-associated form of necroptosis rescues neuronal death in mouse models.

Necroptosis is a regulated form of cell death that has been observed in Alzheimer's disease (AD) along with the classical pathological hallmark lesions of amyloid plaques and Tau neurofibrillary tangles. To understand the neurodegenerative process in AD, we studied the role of necroptosis in mouse models and primary mouse neurons. Using immunohistochemistry, we demonstrated activated necroptosis-related proteins in transgenic mice developing Tau pathology and in primary neurons from amyloid precursor protein (APP)-Tau double transgenic mice treated with phosphorylated Tau seeds derived from a patient with AD but not in APP transgenic mice that only exhibited β-amyloid deposits. Necroptosis proteins in granulovacuolar degeneration (GVD) bodies were associated with neuronal loss in mouse brain regions also known to be vulnerable to GVD in the human AD brain. Necroptosis inhibitors lowered the percentage of neurons showing GVD and reduced neuronal loss, both in transgenic mice and in primary mouse neurons. This suggests that a GVD-associated form of necroptosis that we refer to as "GVD-necroptosis" may represent a delayed form of necroptosis in AD. We propose that inhibition of necroptosis could rescue this type of neuronal death in AD.

Spinal Upper Thoracic Extradural Meningioma: A Case Report and Literature Review

The most common extradural spinal lesions are metastatic tumors. However, approximately 2.5% to 3.5% of spinal meningiomas are extradural meningiomas. This article describes a rare case of a thoracic extradural meningioma. A 58-year-old woman was admitted following two months of gait disturbance. Magnetic resonance imaging suggested an extradural meningioma at the T1-5 level. Radical surgical resection was performed, and the lesion was pathologically identified as meningothelial meningioma. Additionally, we reviewed and summarized 12 cases of spinal extradural masses since 2018. Based on the literature, we discuss the location, pathology, and clinical outcomes of these uncommon lesions.

Canine Multiple System Degeneration Associated with Sequence Variants in SERAC1

Canine multiple system degeneration (CMSD) is an early onset, progressive movement disorder affecting Kerry Blue Terriers and Chinese Crested dogs. The associated pathologic lesions include degeneration of the cerebellum, caudate nucleus, and substantia nigra. CMSD is inherited as an autosomal recessive trait in both dog breeds. Previous linkage mapping localized the CMSD locus to a 15 MB region on canine chromosome 1 (CFA1). Next-generation sequencing was used to generate whole-genome sequences from the DNA of an affected dog from each breed. The resulting sequence reads were aligned to the NCBI canine reference genome (build 3.1). Among the homozygous sequence variants within the CFA1 target region, a nonsense variant in exon 15 of SERAC1 was identified in the affected Kerry Blue Terrier, while in the Chinese Crested dog, a 4 bp deletion in the SERAC1 exon 4 acceptor splice site was found. RT-PCR showed that this deletion resulted in exon 4 skipping. Genotyping of large cohorts of Kerry Blue Terriers and Chinese Crested dogs for the respective breed-specific SERAC1 variants showed complete concordance between genotype and disease phenotype. Genotype–phenotype concordance was also observed in offspring generated by cross breeding between SERAC1-heterozygous Kerry Blue Terrier and Chinese Crested dogs, with only the compound heterozygotes exhibiting the disease phenotype, further confirming the recessive inheritance of CMSD. Variants in human SERAC1 are associated with disorders with a range of ages of disease onset and patterns of clinical signs, but that are all characterized by movement abnormalities similar to those of the dogs with CMSD. Canine CMSD could serve as a valuable model to elucidate the mechanisms underlying SERAC1-deficiency disorders and to evaluate potential therapeutic interventions.

Immunohistochemical Evaluation of p300, H2AacK5 and H3AcK27 in Odontogenic Cysts and Tumors.

The acetylation of histones H2A on lysine 5 (H2AacK5) and H3 on lysine 27 (H3AcK27) modulate several cellular mechanisms through the p300 enzyme in pathological lesions; however, their role in odontogenic lesions has not been addressed. This study aims to evaluate the immunoexpression of p300, H2AacK5, and H3AcK27 in samples of ameloblastoma (AMB) (n = 30), odontogenic keratocyst (OK) (n = 15), adenomatoid odontogenic tumor (AOT) (n = 10), odontogenic fibroma (OF) (n = 8), calcifying odontogenic cyst (COC) (n = 8), odontogenic myxoma (MIX) (n = 10), and ameloblastic fibroma (AF) (n = 06). The percentage of p300-positive cells was higher in AOT and decreased in COC, OK, AMB, AF, OF, and MIX. H2AacK5-positive cells were higher in AF and decreased in AOT, COC, OK, OF, AMB, and MIX, whereas H3acK27-positive cells were higher in AOT and decreased in COC, OK, AF, OF, AMB, and MIX. The expression of these proteins was higher in nonaggressive lesions in comparison to aggressive lesions. There was a positive correlation between p300 and H2AacK5, and H3acK27 in AMB, MIX, and OF, whereas there was a positive correlation between p300 and H2AacK5 in AOT and COC. The histone acetylation may be involved in the biological behavior of these lesions, which could be used to improve their diagnosis and treatment.

Apoptosis, inflammatory and innate immune responses induced by infection with a novel goose astrovirus in goose embryonic kidney cells.

Since 2016, a highly lethal visceral gout induced by infection with the novel goose astrovirus (GoAstV) resulted in an ongoing outbreak in goslings in China, with a mortality rate ranging from 10% to 50%, and causing considerable economic losses in the goose industry. However, the pathogenesis of GoAstV and the molecular mechanism by which kidney lesions are induced by GoAstV infection are unclear. In the present study, a GEK cell infection model for GoAstV was established, and the apoptosis, inflammatory and innate immune responses induced by GoAstV were investigated in GEK cells. The results shown that the expression of proapoptotic proteins, including Bax, caspase-3, caspase-9 and cytochrome c, increased in the infection group; however, the expression of the antiapoptotic protein Bcl-2 decreased, indicating that apoptosis was induced by GoAstV infection in GEK cells. Besides, the activation of the RIG-I/MDA5 pathway and the downstream upregulation of proinflammatory cytokines, including the adapter proteins MAVS, IRF7 and NF-κB and the proinflammatory cytokines IL-6, IL-8 and TNF-α, were detected in GEK cells infected with GoAstV. In addition, GoAstV infection induces the activation of the NLPR3 pathway and further stimulates the increased production of IL-1β. In summary, the present study revealed that GoAstV infection could induce apoptosis and the activation of the RIG-I/MDA5 and NLRP3 pathways in GEK cells, as well as the massive release of proinflammatory cytokines. These results are helpful for elucidating the molecular mechanism of pathological lesions in the kidney in gout goslings infected with GoAstV and the interaction between GoAstV and the innate immune system of the host.

Pathomorphological changes in the lung tissues of Syrian hamsters during experimental infection with SARS‐COV‐2

The new coronavirus infection caused by SARS‐CoV‐2 is a dangerous respiratory disease. The aim of the investigation was to study the pathomorphological changes in lungs of Syrian hamsters infected with SARS‐CoV‐2 as is necessary for adequate therapy and prevention of the disease.Syrian hamsters of the SPF category were infected intranasally with a dose of 5×105TCID50 SARS‐CoV‐2/human/RUS/Nsk‐FRCFTM‐1/2020). Animals were euthanised on days 3, 6, 10, 14 and 21 after infection and the lungs were collected. To determine virus replication real‐time RT‐PCR was used. The lungs was used for histological examination. Statistics was performed using Statistics for Windows 10 software.Specific pathological lesions characterising the inflammatory process were detected in all groups of animals. The severity of pathological changes and the volume of lung tissue lesions varied depending on the stage of the disease. The most severe lesions were observed on days 6–10. By day 21, the process of organ structure restoration was noticed.The study showed that pathological changes in the Syrian hamster’s lungs caused by experimental infection with the SARS‐CoV‐2 were multifaceted and complex. In mild cases, congestion and infiltration are observed, and in severe cases, atelectasis and pulmonary edema were life‐threatening. The most severe lesions in lungs were noted on days 6–10. By day 21, the process of restoration was observed.

Computed tomography of the equine caudal spine and pelvis. Pathological findings in 56 clinical cases (2018-2023).

Computed tomography (CT) of the axial skeleton is increasing across many equine hospitals. CT of the pelvis and caudal spine in a large group of clinical cases has not been reported previously. To describe the pathological lesions identified in the caudal spine/pelvis in horses and ponies undergoing CT spine of this region. A retrospective case series. Horses with CT imaging of the caudal spine/pelvis were included. Horses aged under 6 months and those with CT examinations performed post-mortem were excluded. Fifty-six horses met the inclusion criteria. Ages ranged from 8 months to 20 years and bodyweights from 85 to 680 kg (mean 488 kg). Horses presented predominantly for lameness (30/56) and poor performance (18/56). Osseous pathology was identified in 41/56 horses; including osteoarthritis of the sacroiliac joint(s) (n: 28), pathology of the intervertebral disc joint(s) (n: 12), pelvic fractures (n: 9), osteoarthritis of the coxofemoral joint(s) (n: 8), ventral spondylosis (n: 6), acetabular rim fracture (n: 2), dislocation of coxofemoral joint(s) (n: 2), and dorsal dermal sinus of the sacrum (n: 1). The relationship between CT imaging findings and clinical signs in horses remains unclear. Further work is required to describe the relationship between congenital, developmental, and acquired changes in the caudal spine and pelvis, and clinical signs. CT of the caudal spine and pelvis can be utilised in horses and ponies for diagnosing a range of clinical disorders that may be causing 'lumbosacroiliac pain', poor performance, hindlimb lameness, and stiffness. The pathologies we observed were diverse and many patients had multiple lesions.

The overview of imaging protocols for chest CT

Computed Tomography (CT) is a common method of choice in the diagnosis of thoracic diseases. Since CT operates on the principle of ionizing radiation and frequently involves the use of contrast agents, it is crucial to standardize CT protocols to reduce the need for repeat imaging and, consequently, minimize patient exposure to radiation. The selection of a CT protocol primarily depends on the patient’s clinical indications and needs. The main classification of CT protocols distinguishes between the use of contrast agents (CECT) and non-contrast protocols (NCCT). The LDCT protocol is characterized by a low radiation dose and high sensitivity for detecting pulmonary nodules, making it suitable for lung cancer screening. Ultra-LDCT yields satisfactory results in diagnosing pneumonia and pneumothorax. Cine CT enables the assessment of cardiac function throughout the entire cardiac cycle, though it involves a high radiation dose and low temporal resolution. The use of contrast agents is particularly beneficial for differentiating adjacent non-vascular structures, more accurately identifying vascular anatomy, and improving the detection and characterization of pathological lesions. For diagnosing vascular pathologies, CTA is used, while CTPA is essential for diagnosing pulmonary embolism (PE) with high sensitivity and specificity. TRO CT is useful in cases of acute chest pain to rule out emergencies. Dynamic changes in tissue perfusion are monitored with DCE-CT, which is also valuable in tumor diagnostics. In pediatric applications of CT for the chest, it is essential to emphasize the use of the lowest possible radiation dose and contrast agent to minimize risks.

Placental pathology in SARS-CoV-2 infected pregnancies: A single-institution retrospective cohort analysis.

Our objectives were to determine 1) the prevalence and description of placental pathologic lesions in pregnancies complicated by SARS-CoV-2 infection compared to healthy controls and 2) whether the prevalence and/ or pattern of placental pathologic lesions differed in the few neonates who tested positive for SARS-CoV-2 in the first 48 hours of life at a busy urban county hospital. This study included all pregnant mothers who tested positive for SARS-CoV-2 and delivered at our institution from March 2020 to June 2021, while control placentas were collected from term pregnancies without complications. Approximately 90% (n = 380/425) of placentas from pregnancies complicated by SARS-CoV-2 infections had placental pathologic lesions, compared to 32% (n = 16/50) of controls. The predominant lesions were acute histologic chorioamnionitis with or without fetal response (n = 209/380, 55%), maternal vascular malperfusion (n = 180/380, 47%), and other inflammatory lesions (n = 148/380, 39%). Only 14 (2.5%) infants tested positive for SARS-CoV-2 within the first 48 hours of life. There were no significant differences in placental histopathology between infants who tested positive vs. those that were negative for SARS-CoV-2. Placental lesions in mothers who tested positive for SARS-CoV-2 during the first vs. second vs. third pregnancy trimesters, were significantly different in the incidence of inflammatory placental pathologic lesions (n = 9/19, 53% vs. n = 37/98, 49% vs. n = 102/439, 31%, respectively; p < 0.01). A significant proportion of women with SARS-CoV-2 infection during pregnancy at a single county hospital have inflammatory and vascular placental lesions at birth, raising questions regarding their downstream effects and clinical consequences.

Avian astrovirus caused mortality in pheasant (Phasianus colchicus, Linnaeus, 1758) farm inHungary.

We present the clinical symptoms, pathologic lesions and diagnostic possibilities of the avian astrovirus-related mortality in a pheasant colony. In addition to enteritis in chicks, we also confirmed acute nephrosis. The genome section of the astrovirus was detected and verified by polymerase chain reaction (PCR) testing. After sequencing the isolated genome section based on BLAST driver analysis (601-base pair-long) avian astrovirus has the same ORF-1b gene as turkey astrovirus 1 (TAstV1).

Genome-wide identification of the TRAF gene family in humpback grouper (Cromileptes altivelis) and analysis of their expression in response to Vibrio harveyi challenge

TRAF (Tumor necrosis factor receptor-associated factor) proteins are key mediators of signal transduction in cell signaling and immune regulation within the toll-like receptor (TLR) and tumor necrosis factor (TNFR) superfamily. Despite the importance of TRAF genes in teleost innate immunity, study on their functions in C. altivelis is limited. This study utilized bioinformatics methods to identify and named eight TRAF genes (CaTRAF2a, CaTRAF2a-like, CaTRAF2b, CaTRAF3, CaTRAF4a, CaTRAF5, CaTRAF6 and CaTRAF7) in C. altivelis. Phylogenetic, syntenic and molecular evolution revealed that all CaTRAF members were evolutionarily conserved in teleost. Domain analysis indicated the presence of a conserved N-terminal RING finger domain in all CaTRAF proteins. Most CaTRAF proteins also featured a MATH domain at the C-terminal, with the exception of CaTRAF7 which contained seven repeat WD40 domains. In addition, qRT-PCR was used to detect the expression patterns of nine different tissues and eight different embryonic development stages of healthy fish, and it was found that there were spatial and tissue specificities among the members. HE staining revealed evident pathological lesions in the tissues post V. harveyi infection. Atrophy and significant bending of the gill lamellae were observed in the gills, while irregular cell shapes, increased fat vacuoles, and enlarged cell volume were noted in the liver. Intestinal tissues displayed thickening of the muscle layer, elongation of intestinal villi, and increased folds. Moreover, the expression of TRAF gene changed significantly after V. harveyi infection. These results would help to clarify the molecular role of CaTRAF gene in the regulation of immune and inflammatory responses in C. altivelis.

In vitro and in vivo activities of scutellarein, a novel polyphosphate kinase 1 inhibitor against Acinetobacter baumannii infection

BackgroundInorganic polyphosphate (polyP)-targeted polyphosphate kinase 1 (PPK1) has attracted much attention by virtue of its importance in bacterial pathogenicity and persistence, as well as its exclusive presence in microorganisms. However, only very few drugs have been found to be efficacious in inhibiting the Acinetobacter baumannii (A. baumannii) PPK1 protein.ResultsIn this study, we identified Scutellarein (Scu), a potent PPK1 inhibitor that could significantly influence PPK1-regulated motility, biofilm formation, and bacterial persistence, which was further validated by the results of transcriptome analysis. Mechanistic explorations revealed that Scu achieved its enzyme inhibitory activity predominantly through direct engagement with the active center of PPK1. Moreover, the survival rate of Galleria mellonella larvae was increased by about 35% with 20 mg/kg of Scu treatment. The remarkable therapeutic benefits of Scu were also observed in the mouse pneumonia model, shown mainly by reduced bacterial colonization, pathological lesions, and inflammatory factors.ConclusionOur results revealed that Scu could attenuate the pathogenicity and persistence of A. baumannii by interfering with its important kinase PPK1.

Incidence of erysipelas in waterfowl in Poland – clinical and pathological investigations

ABSTRACT 1. Erysipelas in geese and ducks is an infectious disease causing considerable economic losses in the poultry sector in Poland. The aim of this study was to determine the distribution of erysipelas cases in age groups of geese and in periods of the calendar year and to assess macroscopic lesions in birds infected with Erysipelothrix rhusiopathiae. 2. The study used 286 geese and 16 ducks delivered to the laboratory for diagnosis in the years 2019–2021. The birds came from 99 different farms. E. rhusiopathiae from clinical samples were cultured on Columbia blood agar and identified by real-time PCR. Pathological lesions were characterised during anatomopathological examination. 3. Distribution of erysipelas cases in age groups of geese and periods of the calendar year differed significantly from the assumed even distribution. Most cases were noted in August and September in birds aged between 11 and 13 weeks. Necropsy of birds infected with E. rhusiopathiae showed anatomopathological lesions characteristic of generalised infection, affecting multiple organs. 4. The uneven distribution of erysipelas cases in geese in different age groups and periods of the calendar year suggested that both the age of the birds and climatic conditions are predisposing factors for infection.

6857 Adrenal Incidentaloma In A Patient With Surgically Treated Lung Adenocarcinoma A Decade After Complete Remission

Abstract Disclosure: L. Kaur: None. R. Kaur: None. F. Haider: None. A. Iqbal: None. N. Patel: None. Adrenal incidentaloma is an adrenal mass &amp;gt;1 cm in size commonly discovered incidentally in up to 5-7% of patients on imaging performed for reasons other than adrenal causes. Metastasis to the adrenal glands is common due to their rich blood supply, with lung cancer being the most common primary site, followed by the stomach, esophagus and the liver. Bilateral adrenal metastasis is common, however isolated metachronous or synchronous adrenal metastasis is rare, with an incidence of 1-6%. We present a case of incidentally discovered isolated right adrenal mass ten years after curative surgical resection of right lung adenocarcinoma. A 74 year old male with history significant for adenocarcinoma of the right upper lung lobe stage 1A , negative for metastasis status post lobectomy and no adjuvant chemotherapy or radiation 10 years ago presented to the hospital for his routine follow up evaluation. His vitals were within normal limits and physical examination was unremarkable. The follow up diagnostic CT imaging was done which showed an incidental 2.1 x 1.6 x 1.2 cm right adrenal mass without any pathological lesion or lymphadenopathy. A review of CT scan done one year ago revealed no prior adrenal mass or other suspicious findings. The patient was referred to endocrinology for evaluation of the adrenal mass. He denied abdominal or right flank pain, headaches, palpitations, elevated blood pressure, sweating, muscle weakness, weight gain/loss and was healthy appearing. Lab work up including biochemical studies for hormonal over production, including aldosterone-renin ratio, adrenocorticotropic hormone, plasma catecholamines with urine metanephrines and urine cortisol were within physiological ranges. CT scan was repeated after 2 months which revealed right adrenal mass of 3.2 x 1.8 x 1.7 cm in size with heterogeneity and high pre contrast density. Given the patient's history of lung cancer, imaging characteristics and rapid interval increase in size, there was high suspicion for metastatic disease. Other differentials considered due to fast growth rate included adrenocortical carcinoma and less likely adrenal adenoma. A decision was made to proceed with right adrenalectomy for definitive resection and histological diagnosis secondary to quickly growing adrenal mass with no lymphadenopathy. The patient underwent laparoscopic adrenalectomy and the final pathological report was consistent with metastatic lung adenocarcinoma. Postoperatively the patient recovered well. At 2 week and 3 month follow up he reported no concerns. Isolated adrenal metastasis is unusual and rare but may occur in lung cancer patients years after curative resection of the primary tumor and hence long term annual follow up imaging and monitoring is recommended for prompt diagnosis and timely treatment. Presentation: 6/2/2024

12345 Staying Ahead of Cowden’s Syndrome in Differentiated Thyroid Cancer

Abstract Disclosure: M.S. Gordon: None. M.B. Gordon: None. Cowden’s syndrome or multiple hamartoma syndrome, is an uncommon autosomal dominant genodermatosis and is a member of the spectrum of disorders involving mutations in the phosphatase and tensin homolog gene (PTEN). It is associated with differentiated thyroid cancer (DTC), ¾ papillary, including follicular variant (FVPTC), 1/4 follicular (FTC), and other malignancies, including breast (most common), colorectal, renal cell, endometrial and skin cancers. We report a case of Cowden’s syndrome in which the patient presented with FVPTC but had no other apparent indication of a genetic abnormality until she was found to have a melanoma and was noted to have macrocephaly. The patient presented at age 26 with a thyroid nodule of 2.7 cm in maximal dimension. FNA was benign. By age 31 the lesion had grown to 3.3 cm and a repeat FNA showed a follicular neoplasm. She underwent left lobectomy and isthmusectomy revealing a 3.0 cm FVPTC with focal Hurthle cell features. There was capsular irregularity, and subsequently she underwent completion thyroidectomy showing a right sided 8mm FVPTC. She then received 30 mCi I 131. There were no apparent pathologic mucocutaneous lesions, intellectual deficits, and no family history of Cowden’s syndrome. At age 39 she was found to have a Stage IA malignant melanoma of the periumbilical skin which was resected. With two malignancies diagnosed at a relatively young age, she was evaluated for genetic syndromes and it was simultaneously noted that she had macrocephaly with head circumference of 66 cm. (&amp;gt;99 percentile). An analysis of 69 genes by Ambry genetics revealed a pathogenic variant in the PTEN gene (c.388 C&amp;gt;T (p.R130*). PTEN R130* results in a premature truncation of the PTEN protein at amino acid 130 of 403 within the phosphatase tensin-type domain resulting in loss of function. Macrocephaly (2% population frequency) is seen in 80% of patients with PTEN mutations. Twenty percent of patients with thyroid carcinoma and macrocephaly have a PTEN mutation and lifetime risk of melanoma in DTC is 25%. BRAF and RAS mutations may cooperate with PTEN loss and explain the increased co-occurrence of malignancies with BRAF and RAS mutations such as melanoma, FTC, and PTC in Cowden’s syndrome. In conclusion, we suggest that head circumference should be measured in all patients with DTC to screen for PTEN abnormalities. Patients with DTC also should have a thorough skin examination. Presentation: 6/2/2024

Immunomodulatory and growth promotors effects of rosemary (Rosmarinus officinalis) and/or Spirulina with respect to some gene expression on Nile tilapia (Oreochromis niloticus) in Aswan Governorate

The purpose of this work trial was to determine the true impact of spirulina and rosemary in a combination treatment on Nile tilapia performance before experimental infection. Moreover, the effects of these treatments on the liver and kidney functions, the histology of certain organs, and the expression of certain antioxidant and immune-related genes in the liver tissue both before and after Aeromonas hydrophila (A. hydrophila) infection are also included. To achieve this purpose, four diets were prepared: the first was free of additives as a control group (Con), the second contained (SP) spirulina at 7.5 g/kg of diet, the third contained (RM) rosemary at a rate of 10 g/kg of diet, and the fourth one contained rosemary and spirulina as a SP + RM group. The results of the different parameters indicated the growth-stimulant effects of rosemary and spirulina either alone or in a combination when compared with the control group (P ≤ 0.05), with a superior effect to combination treatment. In addition, improved hematological parameters, immunological assays, phagocytic activity and index, and expression of antioxidant and immune-related genes occurred before and after infection. Moreover, there were positive effects of spirulina and rosemary without pathological lesions in the different organs before infection and fewer lesions after infection.