Positive Staining For Vimentin Research Articles

Presumptive injection-site sarcoma in a white tiger (Panthera tigris tigris): A case report

A 6-year-old female White Tiger (Panthera Tigris Tigris) was presented with a history of a recurrent ulcerating mass on the right lumbar wall which initially, was removed by surgery one year before presentation. Cytological and histological findings were consistent with a cutaneous injection site sarcomas. Immunohistochemistry results revealed that the neoplastic cells were strongly positive for vimentin and weakly positive for alpha-smooth muscle actin (SMA), but negative for Cytokeratin AE1/AE3, s100, and Desmin. Positive staining for vimentin and SMA is consistent with myofibroblast reactivity and reflects a continuous inflammatory response seen in feline injection-site sarcomas. Feline injection-site sarcomas are the most serious adverse effect following injection of the vaccine or some other pharmaceutical substances and should be considered in the differential diagnosis of skin swelling in injection sites in the Felidae family. Limited data are available for these tumors in animals outside of domesticated cats. To the best of our knowledge, there exists no available published information on the injection-site sarcoma in tigers. Similar to domestic felids, this case highlights the importance of considerations and management options in vaccination schedules for the reduction of sarcoma risk in wild felids.

Canine transmissible venereal tumour in Morocco: Clinical and pathological findings in 64 dogs – Insights from a descriptive epidemiological study (2020-2023)

Background: Canine transmissible venereal tumour (CTVT) is a widely spread, contagious neoplasm commonly found in dogs. Mostly affects the external genitalia, however, it may also exhibit unusual clinical presentations. Aim: To describe the epidemiology, clinical appearance, cytologic and histopathologic features of dogs with TVT in Morocco. Methods: Within the realm of a nation-wide study on canine and feline tumours in Morocco between September 2020 and March 2023, dogs with histologically diagnosed TVT were identified and data on epidemiologic, clinical as well as cytologic and histologic features compiled and analyzed. Results: A total of 64 cases of canine TVT were diagnosed. 52 dogs were cross-breed (81.2%) while 4 Siberian Huskies (6.2%) and 3 German shepherds (4.7%) were the most affected pure-breed dogs. Median age of dogs at diagnosis was 3 years (range, 1-10years) and male gender was more common (male:female ratio; 1.3:1). Tumour was located exclusively in the genital area in 58 cases (90.6%), whereas 6 dogs (9.4%) had an atypical occurrence of TVT with locations including skin and nasal cavity. Cytology allowed for an early diagnosis in 2 cases. Histology revealed no differences between the genital and extragenital forms. Immunohistochemistry was necessary in 4 cases and revealed positive staining for vimentin and Alpha-1-antitrypsin, negative marking for CD3, CD20 and AE1/AE3, and low cytoplasmic labeling for lysozyme. Conclusion: CTVT is a widely distributed neoplasm in Morocco, mostly showing presence in young, cross-breed, and oftentimes stray dogs. Adequate understanding of this tumour's epidemiological features is necessary for its management and eradication.

Solitary nodule of cutaneous reticulohistiocytosis: A case report

Introduction: Solitary cutaneous reticulohistiocytosis represents a rare form of benign monocyte/macrophage proliferation. On routine histology, these lesions are typically described as large cells with cytoplasm showing ground glass appearance and giant cells. They grow up to 1 cm in size with rare cases exceeding this size. Case Report: This case report of a 28-year-old male demonstrated a nodule of reticulohistiocytosis measuring 2.2 cm in size. Microscopic features showed a well-demarcated nodule in the dermis with large histiocytes with ground-glass eosinophilic cytoplasm, giant cells, and foamy macrophages in a background of mixed inflammatory cells. Immunohistochemical staining showed positive staining for vimentin, CD68, CD31, with focal and patchy positivity for S100, CD43, and CD45 and negative staining for CD1a, langerin, CD21, CD23, CD30, CD34, ERG, D2-40, AE1/AE3, epithelial membrane antigen (EMA), smooth muscle actin (SMA), myogenin, desmin, SOX10, HMB-45, tyrosinase, and MelanA. Conclusion: The microscopic and immunohistochemical findings are characteristic of this entity but it is important to recognize for proper management and differentiation from other malignant lesions.

S1767 Metastatic Solid Pseudopapillary Neoplasm of the Pancreas, Rare Presentation of an Uncommon Tumor

Introduction: Solid pseudopapillary neoplasms (SPN) make up less than 3% of all diagnosed pancreatic neoplasms. Abdominal CT or MRI are the imaging modalities most utilized, and biopsy is necessary to confirm the diagnosis. Resection of the mass is standard of care and the prognosis is quite good, with 5-year survival rates of over 95%. Both recurrence and metastasis of the tumor are exceedingly rare, occurring in only 1-4% of patients. Case Description/Methods: A 26-year-old female presented with several years of abdominal pain. CT scan revealed a 10cm mass in the neck and body of the pancreas and patient underwent a hybrid resection including subtotal pancreatectomy, splenectomy, and cholecystectomy. Pathology showed a neoplasm extending to the inked margins with positive beta-catenin and CD10 nuclear staining with no evidence of metastasis. At the age of 32, the patient presented again with abdominal pain. A CT and PET scan showed numerous LUQ, perirenal, pancreatic, and periadrenal soft tissue densities. Laparoscopic resection of a 3.5x3 cm soft tissue mass near the remnant pancreas was performed, showing fibrous stroma with angulated islands of epithelioid cells with cystic degeneration and positive staining for vimentin, CD56, and beta-catenin. Resection of multiple abdominal soft tissue tumors, in bulk measuring more than 10 cm, as well as complete omentectomy, left adrenalectomy, bilateral salpingo-oophorectomy, appendectomy, and hyperthermic intraperitoneal chemotherapy with cisplatin was performed. Pathology showed multiple metastatic tumors all consistent with SPN. The appendix, left adrenal gland, bilateral ovaries, and all lymph nodes were negative for any tumor. Two years later, MRI revealed 3.0 x 2.1 cm hyperintense lesion in the caudate lobe of the liver. EUS with biopsy was performed, revealing clusters of uniform, bland cells with ovoid nuclei and associated fibrillary stroma circumscribing vessels with a background of hemorrhagic debris (Figure). Immunohistochemistry showed cells positive for vimentin, LEF1, and beta-catenin, again consistent with SPN. Discussion: This is one of the few cases of multiple instances of both recurrence and metastasis of SPN documented in the literature. This case report shows that serial imaging studies and close follow-up are needed even years after resection and that, although rare, recurrence and metastasis can occur more than one time after the initial diagnosis.Figure 1.: Biopsy of the caudate liver lesion showing clusters of uniform, bland cells with ovoid nuclei and associated fibrillary stroma and hemorrhagic debris, consistent with SPN.

S1760 Metastatic Cervical Squamous Cell Carcinoma of the Distal Bile Duct

Introduction: Squamous cell carcinoma (SCC) of the bile duct is sporadic. Most cases are primary. Only 2 cases of cervical SCC metastatic to the bile ducts have been reported. Consideration of this diagnosis is essential in patients who have a history of malignancy and present with symptoms of biliary obstruction. Case Description/Methods: A 63-year-old female presented with persistent abdominal pain, nausea, and vomiting. Mild abdominal tenderness and scleral icterus were noted on physical examination. Bilirubin, AST, and ALT were elevated. Magnetic resonance cholangiopancreatography (MRCP) revealed dilated intra- and extra-hepatic bile ducts; however, there was no evidence of an apparent mass or gallstones. A lesion was observed at the ampullary level measuring around 1 cm that was brushed and biopsied on endoscopic cholangiopancreatography (ERCP). A metal stent was placed for decompression in the common bile duct. Pathology revealed poorly differentiated SCC with an immune profile favoring metastasis from the gynecologic tract. The patient was diagnosed with SCC of the cervix 15 months prior to presentation. A biopsy of the cervical tissue showed poorly differentiated cervical SCC with positivity in CK7 and HMWK, scattered positive staining of vimentin. Chemo-radiation was initiated with Cisplatin, Paclitaxel, and Bevacizumab. Next-generation sequencing (NGS) showed an immunohistochemical profile consistent with gynecological cancers, namely, MLH1, PMS2, MSH2, and MSH6. Pembrolizumab was also started due to positive PDL-1 expression and mutations in ATM and KMT2D. These agents were continued after she underwent the biliary decompression. Discussion: Metastatic SCC of the biliary tract is rare. Due to its low incidence, there is no standardized treatment strategy; however, there are reported cases of surgical resection in addition to chemoradiotherapy. Very few cases of cervical SCC have been reported to spread to gastrointestinal organs. NGS is a modality that has been widely implemented. The combination of immunohistology staining and NGS can aid in the diagnosis and help guide chemotherapy. The genetic variations present a valuable tool to aim the treatment of cervical cancer. While survival rates for patients with cervical carcinoma have improved, treatment remains difficult as not enough cases exist to compare treatment modalities. Limited knowledge is present regarding managing extra-hepatic duct squamous cell carcinoma since it is rare.

Rapid death due to pulmonary epithelioid haemangioendothelioma in several weeks: A case report

A 49-year-old woman was admitted to our hospital because of haemoptysis for 6 days. This patient claimed no medical history except high blood sugar. Chest computed tomography (CT) showed infection and multiple nodules on both sides of the lung. Blood tests showed no obvious abnormalities. Tracheoscopy showed haemorrhagic discharge in the left upper lobe and an old thrombus obstructing the lumen in the anterior basal segment of the right lower lobe. Then, CT-guided percutaneous lung biopsy was performed. The pathological results suggested multiple nodular-like lesions in the submitted tissues, and tumour cells were round or short fusiform, forming a solid nest structure, visible mitosis, and a vascular cavity-like structure containing red blood cells. Immunohistochemistry revealed positive staining for Vimentin, Bcl-2, CD31, and CD34; negative staining for CD68, SMA, CR, and D2-40; and 40% Ki67+ positivity. Based on the earlier data, the patient was diagnosed with pulmonary epithelioid haemangioendothelioma. This patient did not receive any treatment for several reasons. Unfortunately, the patient died 8 weeks after diagnosis. In conclusion, we present a case featuring the rapid death due to PEH.

Intraocular myofibroblastoma tumour of the ciliary body: a case report and literature review

BackgroundInflammatory Myofibroblastoma Tumors (IMTs) are extremely tumour rare in the intraocular.Case presentationA ciliary body tumor was found under slit lamp biomicroscopy in a 55-year-old male first diagnosed with cataract. Then this patient underwent trans-sclera resection via partial lamellar sclerouvectomy and par plans vitrectomy to remove the mass. Hematoxylin and eosin (HE) staining and immunohistochemistry findings showed that the characteristics of the tumor were consistent with IMT.ConclusionsWe reported a rare case of intraocular IMT, which is confirmed by H&E staining, and IHC positive staining for Vimentin, Desmin and ALK, while negative staining for SMA, S-100, ki-67, CK, CD68, and calponin.

Clinicopathological study of hepatic mesenchymal hamartoma and undifferentiated embryonal sarcoma of the liver: a single center study from Iran

BackgroundUndifferentiated embryonal sarcoma of liver (UESL) and hepatic mesenchymal hamartoma (HMH) are two rare entities which mainly affect the pediatric population. The aim of this investigation was to provide a comprehensive overview of the clinicopathologic characteristics of the patients diagnosed with these two conditions in a tertiary referral center in Iran.MethodsIn this retrospective study patients diagnosed with UESL or HMH between 2012 and 2020 were studied. A comprehensive histopathologic evaluation of the cases along with immunohistochemistry evaluation using a panel of antibodies was conducted. Furthermore, clinical, paraclinical, and treatment data and follow up information was collected.ResultsA total of 16 patients (8 UESL, 8 HMH) were studied in this investigation. Patients with UESL had a significantly (p = 0.002) higher age at diagnosis compared with those with HMH. Histologically, UESL cases were characterized by anaplastic cells with eosinophilic cytoplasm and bizarre nuclei and frequent atypical mitosis and spindling in a myxoid stroma while disordered arrangement of hepatic parenchyma, bile ducts, and primitive mesenchyme was seen in HMH. Furthermore, small round cells and extramedullary hematopoiesis were seen in 2 UESL and 3 HMH cases, respectively. Concurrent HMH was also seen in two UESL cases. Immunohistochemistry panel showed positive staining for Vimentin, Glypican-3, Desmin, CD56, CD10, and BCL2 in UESL cases and immunoreactivity for Vimentin, HepPar 1, Glypican-3, SMA, CD56, BCL2, and CD34 in various components of HMH.ConclusionsIn this study, the clinicopathologic features of UESL and HMH cases are presented. We also evaluated the utility of an immunohistochemistry panel in the diagnosis of these two rare entities and suggested novel markers. Our study corroborated the findings of previous investigations and expanded the clinicopathologic features of these two rare entities with diagnostic and potential therapeutic implications.

Glomus Tumor: An Unusual Cause of Hypophosphatemic Osteomalacia

Abstract Background: Tumor-induced osteomalacia (TIO) is a rare condition resulting in hypophosphatemic osteomalacia. We present a rare case of TIO secondary to glomus tumor. Clinical Case: A 39-year-old woman with history of chronic sinusitis presented with progressively worsening generalized body pain and muscle weakness of eight months duration. Examination showed decreased muscle strength in bilateral upper and lower extremities and congenital cleft palate. Laboratory work up revealed elevated alkaline phosphatase 603 U/L (44–147 U/L), low serum phosphorus 1.5 mg/dL (3.5–5.0 mg/dL), normal serum calcium 8.9 mg/dL (8.3–10.4 mg/dL), normal 25-hydroxyvitamin D 32 ng/dL (30–100 ng/dL), elevated 1,25-dihydroxyvitamin D 62 g/mL (20–45 pg/mL), elevated intact PTH level 99.01 pg/mL (8–74 pg/mL), high normal 24 hour urinary phosphate levels 1100 mg/dl, and elevated FGF23 level 128 RU/mL (<108 RU/mL). Fractional excretion of filtered phosphate (FEPO4) [FEPO4 = (Urine phosphate / Serum phosphate) / (Urine creatinine / Serum creatinine) * 100] was 107.54 % (normal range <20%). Tubular reabsorption of phosphate (TRP) [Percentage TRP = 100 * {1- (Urine phosphate / Serum phosphate) / (Urine creatinine / Serum creatinine)}] was -7.54 %. Tubular maximum reabsorption of phosphate to glomerular filtration rate (TmP/GFR) calculated using formula [TmP/GFR = TRP x serum phosphate] was -0.1131 mg /dL (2.8–4.2 mg/dL). Bone densitometry revealed normal bone density and parathyroid scintigraphy was negative for adenoma. Clinical symptoms along with biochemical evidence of phosphate wasting confirmed by low TRP and an unsuppressed FGF23 levels suggested oncogenic osteomalacia as underlying etiology. Whole body bone scan demonstrated increased radiotracer uptake in the elbows, spine, sacroiliac joints, knees, ankles and multiple ribs suggestive of inflammatory process. MRI of paranasal sinuses revealed large soft tissue mass occupying right frontal, ethmoid, maxillary and sphenoid sinuses suggestive of sinonasal polyposis. 99mTc-Octreotide scan confirmed increased uptake in the nasopharynx. The sinonasal mass was resected and pathology revealed the mass to be a glomus tumor confirmed on immune histochemical studies with positive staining for vimentin and SMA and Ki67 of 5–10 %. Postoperatively, phosphorus levels normalized to 3 mg/dl on day 7. Conclusion: Glomus tumor as cause of TIO is extremely rare however localization and surgical resection of tumor can result in complete resolution of biochemical and clinical manifestations.

Effects of SET7 on angiotensin II-mediated proliferation and collagen synthesis of myocardial fibroblasts and its mechanisms.

Silence of SET domain containing lysine methyltransferase 7 (SET7) alleviates myocardial tissue injury caused by ischemia-reperfusion. But the effects of SET7 on angiotensin II (Ang II)-induced myocardial fibroblast proliferation and the collagen synthesis are not clear. The purpose of this study was to explore the effect of SET7 on the proliferation and collagen synthesis of myocardial fibroblasts and its mechanisms. Myocardial fibroblasts were isolated and identified by immunofluorescence. Myocardial fibroblasts were randomly divided into 4 groups: a control group (cells were normally cultured), an Ang II group (cells were treated with 100 nmol/L Ang II for 24 h), a siCtrl group (cells were transfected with siRNA control and were then treated with 100 nmol/L Ang II for 24 h), and a siSET7 group (cells were transfected with siRNA SET7 and were then treated with 100 nmol/L Ang II for 24 h). Cell counting kit-8 (CCK-8) and 5-ethynyl-2'-deoxyuridine (EdU) assay were used to evaluate cell proliferation. Real-time PCR was used to detect the mRNA levels of SET7, collagen I, collagen III, and α-smooth muscle actin (α-SMA). Western blotting was used to detect the protein expression of SET7, collagen I, collagen III, α-SMA, sonic hedgehog (Shh), ptched1 (Ptch1), and glioma-associated oncogene homolog 1 (Gli1). Fluorescence microscopy showed positive vimentin staining, and myocardial fibroblasts were in good condition. As compared to the control group, the mRNA and protein levels of SET7 in the Ang II group were significantly upregulated; cell proliferation rate and EdU fluorescence intensity in the Ang II group were significantly increased; the mRNA and protein levels of collagen I, collagen III, and α-SMA were significantly upregulated (all P<0.05). As compared to the siCtrl group, the mRNA and protein levels of SET7 in the siSET7 group were significantly downregulated; cell proliferation rate and EdU fluorescence intensity in the siSET7 group were significantly decreased; the mRNA and protein levels of collagen I, collagen III, and α-SMA in the siSET7 group were significantly downregulated (all P<0.05). Silence of SET7 gene inhibits Ang II-induced proliferation and collagen synthesis of myocardial fibroblasts. Shh signaling pathway may be involved in this process.

Primary Giant Cell Tumors of the Lung: A Clinicopathologic and Immunohistochemical Study of 3 Cases.

Three cases of primary giant cell tumors of the lung akin to those described in the soft tissues are presented. The patients are 3 men between the ages of 43 and 54 years who presented with nonspecific symptoms of cough, chest pain, and shortness of breath. None of the patients had any prior history of malignancy anywhere else. Diagnostic imaging disclosed the presence of an intrapulmonary mass. All the patients underwent lobectomy. Grossly, the tumors were described as solid, slightly hemorrhagic, and measuring between 1.8 and 2.4 cm in greatest diameter. Histologically, the tumors were characterized by a dual population of multinucleated giant cells admixed with a mononuclear proliferation. Nuclear atypia was mild to moderate, and mitotic activity varied but was under 5 mitotic figures per 10 high power fields. Immunohistochemical stains showed positive staining for vimentin, CD68, and cathepsin K, whereas the tumors were negative for keratin, TTF-1, p40, S-100 protein, and SABT-2. Clinical follow-up was obtained in 2 patients who have remained alive and without evidence of recurrence or metastasis up to 12 months after surgery. One patient was lost to follow-up. The current neoplasms represent a tumor that to the best of our knowledge has not been reported as a primary neoplasm of the lung. The cases herein described represent an unusual occurrence and should be maintained in the differential diagnosis of primary pulmonary tumors rich in multinucleated giant cells.

Case report of pulmonary metastasis in a male Wistar rat glioblastoma model

Glioblastoma (GBM) is a highly aggressive central nervous system cancer. Its extracranial metastases have rarely been reported in the past few decades. Moreover, the pathogenesis of extracranial GBM metastases remains unclear. Here, we report a case of pulmonary metastasis in a male Wistar rat of C6 GBM model. This reported Wistar male rat was one of the experimental control group without any other intervention except for C6 GBM cells orthotopic implantation. On postoperative day 15, the animal which was reported in this study showed highly cellular, pleomorphic, tumor with nuclear atypia in the brain (Ki67, approximately 65.7%) and lungs (Ki67, 49.5%). Tumor cells in the lung showed immunoreactivity for glial fibrillary acidic protein. Inflammatory CD68+ cell infiltration, weakly positive E-cadherin, and strongly positive staining for vimentin were observed both in tumors in the brain and lungs. Based on further morphological analysis, we speculate that the potential metastatic route into the lung might be hematogenous metastasis.

Gastric schwannoma (a case report)

The article describes a clinical case of a rare benign tumor of the stomach – schwannoma.A patient was hospitalized for surgical treatment of cholelithiasis, but a tumor-like mass in the stomach was found intraoperatively. The surgery was stopped for meticulous examination of the patient. After further examination, radical treatment was performed - pylorus-preserving stomach resection. Histological examination did not reveal sufficient findings regarding the tumor structure, which required immunohistochemical diagnostics with the following results: the tumor cells showed positive staining for vimentin, protein S-100 and SOX-10, weak positive for CD34, but no staining for desmin, smooth muscle actin, CD117/c-kit, Dog1, pan-cytokeratin. The identified immunophenotype was indicative of gastrointestinal schwannoma.

INFLAMMATORY MYOFIBROBLASTIC TUMOR OF PLEURA: A RARE BENIGN TUMOR

SESSION TITLE: Fellows Disorders of the Pleura Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Inflammatory myofibroblastic tumor (also known as plasma cell granuloma, inflammatory pseudotumor, fibrous histiocytoma, fibroxanthoma, xanthogranuloma) is a rare benign neoplasm which can also be locally invasive. The symptoms and radiological findings are mostly non-specific. It is occasionally reported in lungs with incidence of 0.04 - 0.7% of all lung tumors, whereas in pleura, it is rarely reported. CASE PRESENTATION: A 30yr female non-smoker presented with breathlessness, left sided chest pain for 2 months. CXR- large homogenous opacity in the left hemithorax sparing the left upper zone. HRCT chest - a large multiloculated, multiseptated cystic lesion was found in left pleural cavity with collapse of underlying left lung and mild pleural effusion. Thoracotomy was performed and a large fleshy highly vascular mass was noted of size 30cm x 20cm having variegated margins, adherent to lower lobe of left lung, diaphragm and postero-medial aspect of mediastinum. The tumor was resected in-toto weighing around 4.5kg. HPE of the tissue showed features of INFLAMMATORY MYOFIBROBLASTIC TUMOR. IHC analysis showed positive staining for vimentin and smooth muscle actin(SMA) confirming the diagnosis DISCUSSION: IMT was first described in lungs by Brunn in 1939. It is reported in other extrapulmonary sites like orbit, liver, spleen, thyroid, breast, lymph nodes, skull base and rarely in pleura. Pathogenesis of IMT is still unknown. One Hypothesis is that, IMTs are low grade mesenchymal neoplasms with a secondary inflammatory component. It is supported by the presence of a fusion gene ALK gene, a tyrosine kinase oncogene located on chromosome 2p23, initially found to be arranged in anaplastic large cell lymphomas, leading to overexpression of ALK gene. The cytoplasmic expression of ALK gene is found on immunohistochemistry in some cases of IMT. It is found less commonly in pulmonary IMT than in extrapulmonary IMT. The clinical findings and symptoms are largely non-specific. The symptoms may be cough, dyspnea, chest pain, hemoptysis, fever and fatigue. Weight loss and anorexia are rare. Approximately 70 percent of patients are asymptomatic and tumor discovered incidentally on chest x-ray. Approximately 50 percent of the patients have an elevated sedimentation rate, mild anemia and thrombocytosis can also occur. The diagnosis of IMT requires the presence of characteristic pathological features- a background proliferation of spindle cells associated with a variable dense polymorphic infiltrate of mononuclear inflammatory cells CONCLUSIONS: IMT is a rare benign tumor. Clinical and radiological presentation is variable and nonspecific and diagnosis can be made only by histopathological and immunohistochemical studies. Despite being benign, its potential for recurrence and local invasion requires complete surgical resection. 4.5 kg of IMT pleura was never reported in literature till now. Reference #1: R. J. Cerfolio, M. S. Allen, A. G. Nascimento et al., “Inflammatory pseudotumors of the lung,” Annals of Thoracic Surgery, vol. 67, no. 4, pp. 933–936, 1999. Reference #2: J. Loeffler-Ragg, J. Bodner, M. Freund et al., “Diagnostic and therapeutic challenges of a large pleural inflammatory myofibroblastic tumor,” Case Reports in Pulmonology, vol. 2012, Article ID 102196, 5 pages, 2012. Reference #3: C. M. Coffin, A. Patel, S. Perkins, K. S. J. Elenitoba-Johnson, E. Perlman, and C. A. Griffin, “ALK1 and p80 expression and chromosomal rearrangements involving 2p23 in inflammatory myofibroblastic tumor,” Modern Pathology, vol. 14, no. 6, pp. 569–576, 2001. DISCLOSURES: No relevant relationships by PRAPULLA CHANDRA DAVULURI, source=Web Response

S1601 Malignant Melanoma of the Gallbladder Masquerading as Cholangitis and Cholecystitis

INTRODUCTION: Metastatic Malignant melanoma is reported in the stomach, intestine and colon. The involvement of the gallbladder and the bile duct are extremely rare. CASE DESCRIPTION/METHODS: A 61-year-old male presented with abdominal pain, nausea, vomiting, fever, chills, and 10lb weight loss. Physical examination was notable for right upper quadrant abdominal tenderness with a positive Murphy’s sign and minimal jaundice. Lab data showed no leukocytosis and normal hemoglobin. Elevated liver tests with Alk Phos 435U/L, ALT 546U/L, AST 474U/L, and Tbili 3.1mg/dl prompted an abdominal ultrasound which showed intrahepatic and extrahepatic bile duct dilatation (common bile duct (CBD) 11mm). A diffusely abnormal thick-walled gall bladder filled with debris was seen. This was concerning for cholecystitis and cholangitis. He was started on piperacillin/tazobactam. An endoscopic ultrasound (EUS) revealed hyperechoic material suggestive of thick sludge versus tissue within gallbladder lumen extending into the CBD (Figure 1a). Endoscopic retrograde cholangio-pancreatography (ERCP) revealed irregular filling defects within CBD close to cystic duct takeoff (Figure 1b). After sphincterotomy, balloon sweeps evacuated pigmented tissue debris (Figure 1c) which was retrieved and sent for pathology. Unusual EUS/ ERCP findings prompted an MRI which showed high T1 signal within periportal nodes and gallbladder suggesting hemorrhage. Surgical consultation was obtained and patient underwent laparoscopic cholecystectomy, but frozen section indicated malignancy, therefore, an open liver resection and lymphadenectomy was completed. The gross pathology showed a 2.5 × 1.6 × 1.5cm mass arising from the gallbladder (Figure 2a) with invasion into the peri muscular connective tissue on the hepatic side but with no direct extension. An immunostain on the tumor and the prior biliary tissue debris showed positive staining for Vimentin, and S100 and a diagnosis of melanoma was confirmed (Figures 2b and 2c). Surgical staging was pT2bN1. Skin and ocular examination did not reveal any lesions. DISCUSSION: Melanoma involving the gastrointestinal tract is usually metastatic from known cutaneous melanoma; however primary melanoma of the GI tract have been reported. Within the GI tract, primary gallbladder melanoma is extremely rare with less than 40 cases reported in the literature. Clinical course is typically aggressive; our patient developed metastatic disease to brain soon after gallbladder resection.Figure 1.: EUS and ERCP image.Figure 2.: Pathology image.

Quercetin Inhibits Adenomyosis by Attenuating Cell Proliferation, Migration and Invasion of Ectopic Endometrial Stromal Cells.

PurposeTo evaluate the effects of quercetin on proliferation, invasion and migration of endometrial stromal cells (ESCs) from adenomyosis patients.MethodsPrimary ectopic ESCs (EESCs) and eutopic ESCs (EuESCs) were obtained and purified from patients undergoing total hysterectomy for adenomyosis and identified by immunocytochemistry staining. The cytotoxicity and inhibition rate were determined by CCK-8 assay to obtain the IC50 value. Cell proliferative, migratory, and invasive abilities were detected by BrdU, wound scratch, transwell assays, respectively. Western blot analysis was employed to explore the effects of quercetin on the expression of MMP-2, MMP-9, Ezrin and Fascin proteins in cells.ResultsBoth EESCs and EuESCs were characterized with strongly positive staining for vimentin and almost negative for cytokeratin. Quercetin inhibited the viability of EESCs and EuESCs in a dose- and time-dependent manner, with an IC50 = 33.00 μM for EuESCs and IC50 = 74.88 μM for EESCs at 72 h. Thus, the final concentrations and action time of quercetin in EuESCs (0, 20, 40, and 80 μM for 72 h) and EESCs (0, 40, 80, and 160 μM for 72 h) were selected. BrdU assay showed that quercetin dose-dependently suppressed the proliferation of EESCs and EuESCs, while the inhibition rate in EESCs was higher. Similarly, administration of quercetin in EESCs and EuESCs significantly decreased the motility and invasiveness in a dose-dependent fashion, with stronger inhibitory effects on EESCs. Finally, Western blot analysis demonstrated that invasion- and migration-related proteins (MMP-2, MMP-9, Erzin, and Fascin) were significantly downregulated with the quercetin concentration increasing. Moreover, the decreased level of these proteins in EESCs under quercetin exposure was greater than that in EuESCs.ConclusionQuercetin can inhibit the proliferation of EESCs in adenomyosis and reduce their mobility and invasiveness. These inhibitory effects may be related to the downregulation of MMP-2, MMP-9, Fascin, and Erzin proteins.

Isolation, characterization, and cryopreservation of collared peccary skin-derived fibroblast cell lines.

BackgroundBiobanking of cell lines is a promising tool of support for wildlife conservation. In particular, the ability to preserve fibroblast cell lines derived from collared peccaries is of significance as these wild mammals are unique to the Americas and play a large role in maintaining the ecosystem. We identified collared peccary fibroblasts by immunofluorescence and evaluated their morphology, growth and adherence capacity. Further, we monitored the viability and metabolic activity of the fibroblasts to determine the effects of passage number and cryopreservation on establishment of cell lines.MethodsSkin biopsies were collected from the peripheral ear region from five adult animals in captivity. Initially, cells were isolated from fragments and cultured in the Dulbecco’s modified Eagle medium supplemented with 10% fetal bovine serum and 2% antibiotic–antimycotic solution under a controlled atmosphere (38.5 °C, 5% CO2). We evaluated the maintenance of primary cells for morphology, adherence capacity of explants, explants in subconfluence, cell growth and absence of contamination. Moreover, we identified the fibroblast cells by immunofluorescence. Additionally, to evaluate the influence of the number of passages (first, third and tenth passage) and cryopreservation on establishment of cell lines, fibroblasts were analysed for the viability, metabolic activity, population doubling time (PDT), levels of reactive oxygen species (ROS), and mitochondrial membrane potential (ΔΨm).ResultsAll explants (20/20) adhered to the dish in 2.4 days ± 0.5 with growth around the explants in 4.6 days ± 0.7, and subconfluence was observed within 7.8 days ± 1.0. Moreover, by morphology and immunocytochemistry analyses, cells were identified as fibroblasts which presented oval nuclei, a fusiform shape and positive vimentin staining. No contamination was observed after culture without antibiotics and antifungals for 30 days. While there was no difference observed for cell viability after the passages (first vs. third: P = 0.98; first vs. tenth: P = 0.76; third vs. tenth: P = 0.85), metabolic activity was found to be reduced in the tenth passage (23.2 ± 12.1%) when compared to that in the first and third passage (100.0 ± 24.4%, P = 0.006). Moreover, the cryopreservation did not influence the viability (P = 0.11), metabolic activity (P = 0.77), or PDT (P = 0.11). Nevertheless, a greater ΔΨm (P = 0.0001) was observed for the cryopreserved cells (2.12 ± 0.14) when compared to that in the non-cryopreserved cells (1.00 ± 0.05). Additionally, the cryopreserved cells showed greater levels of intracellular ROS after thawing (1.69 ± 0.38 vs. 1.00 ± 0.22, P = 0.04).ConclusionsThis study is the first report on isolation, characterization and cryopreservation of fibroblasts from collared peccaries. We showed that adherent cultures were efficient for obtaining fibroblasts, which can be used as donor cells for nuclei for species cloning and other applications.

Clinical Characteristics and Surgical Features of Intracranial Fibrosarcoma.

Intracranial fibrosarcoma is an extremely rare neoplasm in the central nervous system. Insofar there were only sporadic case reports describing its features. The purpose of this study is to review the clinical and surgical features of cases who were treated in our department. The authors retrospectively reviewed and detailed the clinical and surgical data obtained from 5 patients with fibrosarcoma who underwent treatment at our institute between January 2009 and January 2019. There were 3 males and 2 females including 2 juvenile and 3 senior patients. The most frequent sign was intermittent pain and vomiting. The location of the tumor included middle fossa, thalamus and midbrain, sellar and suprasellar region and right parietal-occipital lobe. Surgical observation demonstrated the consistency of the tumor was tenacious with abundant blood supply. Gross total resection was achieved in 2 cases. Pathological analysis showed spindle cells in a herringbone form with positive Vimentin staining in all 5 cases, with the absence of GFAP or S-100. All 5 patients were deceased eventually after a varied period of time after the first surgery. Intracranial fibrosarcoma was a highly malignant entity presented in the central nervous system. Surgery still remains the first-line treatment followed by radiotherapy, however, the prognostic outcome was very poor. Future studies should be more focused on accumulation of the relevant information on this disease thus hopefully in assisting to developing more optimized treatment.

Unclassified sex cord / gonadal stromal testis tumour with a pure spindle cell component

Incompletely differentiated sex cord / gonadal stromal tumours of the testis (SCST) of pure spindle cell morphology are extremely rare with only four reported cases in the literature.1 We report a case of a 73-year-old man who presented with acute on chronic renal failure and noted to have an enlarged tender left testicle. Ultrasound examination revealed an enlarged testis (40 cc) with diffuse heterogeneity of the testicular parenchyma. A radical orchiectomy procedure was performed. The histological examination revealed a well circumscribed tumour (55 mm in maximum diameter) comprised purely of fascicles of spindle cells with elongated to ovoid nuclei. Immunohistochemical stains demonstrated positive staining for Vimentin, S100, SMA, Inhibin, Calretinin and CD99. EMA, Cam 5.2, AE1&3, Desmin, CD34, Melan-A, HMB-45, Sox10, CD117 and PLAP stains were negative. The overall features were consistent with the diagnosis of unclassified SCSTs of pure spindle cells morphology. Due to the rarity, SCST of spindle cell morphology are under studied. They are of unknown clinical behaviour. However, they should be considered in the differential diagnosis of spindle cell lesions of the testis.

Hemangioblastoma-like Clear Cell Stromal Tumor of the Lung: A Clinicopathologic and Immunohistochemical Study of 5 Cases.

Five cases of an unusual primary benign stromal tumor designated as hemangioblastoma-like clear cell stromal tumor of the lung are presented. The patients are 4 women and 1 man between the ages of 39 and 52 years of age (average: 45.5 y). The patients presented with nonspecific symptoms of cough, chest pain, or dyspnea. None of the patients had any prior history of malignancy or tumor elsewhere. Diagnostic imaging showed the presence of an intrapulmonary tumor. Lobectomy was performed in all 5 patients. Grossly, the tumors were well-demarcated but not encapsulated with focal areas of hemorrhage without necrosis. Histologically, low power examination showed a cellular proliferation alternating with discrete dilated vessels reminiscent of a vascular neoplasm. Higher magnification showed medium-sized cells with clear cytoplasm arranged in sheets and cords. Mitotic activity and marked cellular atypia were not present. A wide panel of immunohistochemical studies was performed including epithelial, neural, muscle, vascular, and neuroendocrine markers, all of which showed negative staining. Tumor cells showed positive staining for vimentin. In 2 cases, fluorescence in situ hybridization for the solitary fibrous tumor was performed and was negative. Clinical follow-up in 3 patients showed no evidence of recurrence. The cases herein presented highlight an unusual benign stromal tumor of the lung, which needs to be considered in the differential diagnosis of tumors with a clear cell and vascular appearance.