Presence Of Lipid-laden Macrophages Research Articles

Lipoid Pneumonia: Siphoning of Gasoline

Abstract Lipoid pneumonia is a rare condition that accounts for 1%–2.5% of all pneumonia. There are two types – exogenous and endogenous. In recent days, exogenous lipoid pneumonia has been on an increasing trend due to the exponential use of vaping. Exogenous lipoid pneumonia usually presents with cough, fever, breathlessness, chest pain, and weight loss. Usually, it is a diagnosis of exclusion and the presence of lipid-laden macrophages is required for its diagnosis. Here, we present a case of lipoid pneumonia which showcased the importance of detailed clinical history elicitation, approach, and management of lipoid pneumonia.

Unusual Case of Xanthogranulomatous Mastitis with Florid Ductal Epitheliosis, Masquerading Clinically as Neoplastic Breast Lesion

Xanthogranulomatous inflammation is a rare form of chronic inflammation characterized by the presence of lipid-laden macrophages, multinucleate giant cells, and chronic inflammatory cells. It is an uncommon finding in the breast. Obstruction, infection with low-virulence organisms, defective lipid transport, autoimmune disorders, and allergic reactions have been implicated. Very few reports of xanthogranulomatous mastitis (XGM) have been reported in which coexistent benign and malignant lesions have been found. Clinical presentation of XGM is variable. Many patients present with pain and breast lumps. The lesions can mimic benign or malignant breast neoplasms clinically and radiologically which warrant a pathological diagnosis either by core or excisional biopsy. Histopathology examination is the key for diagnosis. Surgical excision is the choice of treatment. Larger lesions can be treated conservatively with antibiotics before surgical excision.

Candida albicans Induces Foaming and Inflammation in Macrophages through FABP4: Its Implication for Atherosclerosis.

Atherosclerosis is a chronic degenerative disorder characterized by lipid-dense plaques and low-grade inflammation affecting arterial walls. Foamy macrophages are important in the formation of atherosclerotic plaques and the induction of low-grade inflammation. The presence of lipid-laden macrophages has occurred in infections caused by opportunistic pathogens. Candida albicans is the major cause of candidiasis in immunocompromised patients, including those with diabetes mellitus. However, the role played by C. albicans in macrophage foaming and the associated inflammation is poorly understood. We investigated whether C. albicans induces foaming along with inflammation in macrophages and, if so, by which mechanism(s). We incubated THP-1 macrophages with heat-killed C. albicans (HKCA). HKCA-induced lipid accumulation in macrophages along with increased expression of inflammatory markers, including CD11b and CD11c or expression and secretion of IL-1β. HKCA also increased the expression of PPARγ, CD36, and FABP4 in macrophages. Mechanistically, we found that the foamy and inflammatory macrophage phenotype induced by HKCA requires FABP4 because disruption of FABP4 in macrophages either by chemical inhibitor BMS309404 or small interfering RNA (siRNA) abrogated foam cell formation and expression of inflammatory markers CD11b, CD11c, and IL-1β. Furthermore, HKCA-treated macrophages displayed high expression and secretion of MMP-9. Inhibition of FABP4 resulted in suppression of HCKA-induced MMP-9 production. Overall, our results demonstrate that C. albicans induces foam cell formation, inflammation, and MMP-9 expression in macrophages via the upregulation of FABP4, which may constitute a novel therapeutic target for treating C. albicans-induced atherosclerosis.

Positive bronchoalveolar lavage pepsin assay associated with viral and fungal respiratory infections in children with chronic cough.

To assess the association between commonly obtained endoscopic and serologic data and bronchoalveolar lavage pepsin assay (BAL) results in children with chronic cough. We performed a retrospective chart review of 72 children with a BAL pepsin obtained through our Aerodigestive Center over an 18-month period. BAL outcomes include evidence of viral, bacterial, or fungal infection, presence of lipid-laden macrophages, and cytology (eosinophils, neutrophils, and lymphocytes). Gastrointestinal outcomes include esophagogastroduodenoscopy (EGD) and pH impedance probe findings. Other characteristics include serum eosinophils, neutrophils, and lymphocytes; spirometry; FeNO; and IgE. Seventy-two patients underwent BAL pepsin testing. Median age was 4.9 years, 30.6% had severe persistent asthma, and 59.2% were on reflux medication. There was an association between positive BAL pepsin assay and positive viral panel (p = .002) or fungal culture (p = .027). No significant association found between positive BAL bacterial culture; BAL cytology; the presence of BAL lipid-laden macrophages; IgE; spirometry; FeNO; CBC neutrophil, eosinophil, or lymphocytes; pH impedance testing parameters; or EGD pathology. BAL pepsin is associated with a positive BAL viral PCR or fungal culture. Lack of correlation between pepsin-positivity and pH-impedance parameters or EGD pathology suggests microaspiration may be due to an acute event (such as a respiratory infection) rather than chronic gastroesophageal reflux disease. This may be especially true in the presence of a positive viral panel or fungal culture when a BAL pepsin is obtained.

LIPID LADEN MACROPHAGES IN E-CIGARETTE OR VAPING PRODUCT USE-ASSOCIATED LUNG INJURY

SESSION TITLE: Medical Student/Resident Tobacco Cessation and Prevention Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Electronic-cigarette or vaping, product use-associated lung injury (EVALI) was first reported to the CDC in August 2019 and has to lead to a significant number of hospitalizations and deaths [1]. Various patterns of acute lung injury including diffuse alveolar damage, acute fibrinous pneumonitis, and organizing pneumonia have been described in association with EVALI [2]. However, the presence of lipid-laden macrophages in BAL has been consistently noted in some series of EVALI [3]. Here, we present a unique case of EVALI in which a very high number of lipid-laden macrophages were noted. CASE PRESENTATION: A 44-year-old man who had been vaping nicotine and THC regularly presented with progressively worsening dyspnea. He was febrile, tachycardic, tachypneic and hypoxemic upon presentation. Computed tomography of the chest revealed multi-focal bilateral hazy ground-glass opacities with subpleural sparing and inter-lobular septal thickening. He underwent flexible bronchoscopy for further evaluation. Bronchoalveolar lavage (BAL) showed a high number of lipid-laden macrophages on the oil-red-O stain with a Colombo count over 200. He was started on systemic corticosteroids for presumed EVALI resulting in significant improvement of his condition. He was discharged home in stable condition on day 6 of admission. DISCUSSION: A total of 2,807 hospitalized EVALI cases with 68 reported deaths have been confirmed by the Centers for Disease Control and Prevention in the United States with a majority of cases being associated with tetrahydrocannabinol containing products. Radiographic abnormalities of interlobular septal thickening along with bilateral hazy ground-glass opacities have been described with this condition and histopathological features include acute fibrinous pneumonitis, diffuse alveolar damage, lipoid pneumonia and organizing pneumonia. Lipid-laden macrophages in BAL fluid have been noted in many patients with EVALI but the significance of lipid-laden macrophages in diagnosing this condition remains unclear. However, the presence of lipid-laden macrophages in a patient with a history of electronic-cigarette or vaping product use and no evidence of infection should strongly suggest a diagnosis of EVALI. To our knowledge, no previous case with such a high number of lipid-laden macrophages has been reported. CONCLUSIONS: A rapid identification tool for EVALI is required given the current outbreak. The presence of lipid-laden macrophages in the BAL fluid may serve as such a marker in the appropriate clinical setting. Prompt treatment with systemic corticosteroids should be considered once lipid-laden macrophages are identified in patients with a history of vaping. Reference #1: Perrine CG, Pickens CM, Boehmer TK, et al. Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping - United States, 2019 [published correction appears in MMWR Morb Mortal Wkly Rep. 2019 Oct 11;68(40):900]. MMWR Morb Mortal Wkly Rep. 2019;68(39):860-864. Published 2019 Oct 4. doi:10.15585/mmwr.mm6839e1 Reference #2: Butt YM, Smith ML, Tazelaar HD, et al. Pathology of Vaping-Associated Lung Injury. N Engl J Med. 2019;381(18):1780-1781. doi:10.1056/NEJMc1913069 Reference #3: Maddock SD, Cirulis MM, Callahan SJ, et al. Pulmonary Lipid-Laden Macrophages and Vaping. N Engl J Med. 2019;381(15):1488-1489. doi:10.1056/NEJMc1912038 DISCLOSURES: No relevant relationships by Moeezullah Beg, source=Web Response No relevant relationships by Mahnoor Mir, source=Web Response No relevant relationships by Jay Peters, source=Web Response

EVALI: A CASE SERIES ON YOUNG INDIVIDUALS DEVELOPING INTERSTITIAL PNEUMONITIS IN SOUTHERN CALIFORNIA

SESSION TITLE: Medical Student/Resident Occupational and Environmental Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Vaping or e-cigarettes use has been previously marketed as a safe alternative to smoking. However, the outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) has become a public health disaster leading to the hospitalization of thousands of young, healthy individuals. Currently there is limited data available on the residual lung disease that develops after EVALI. CASE PRESENTATION: The case series included 8 patients, ages 21-46, hospitalized in the Southern California region during 2019. They presented with symptoms of unexplained dyspnea that were found to be responsive to corticosteroid treatment. All met the CDC surveillance case definition for severe pulmonary disease associated with e-cigarette use (1). DISCUSSION: The case series demonstrated heterogenous patterns of airway-centered, bronchiolocentric, interstitial pneumonia concerning for inhalation-induced lung injury. Common radiographic patterns included patchy consolidations (7/8, 87.5%), ground-glass opacification (8/8, 100%), centrilobular nodules (8/8, 100%), subpleural sparing (5/8, 62.5%), interlobular septal thickening (8/8, 100%), bronchial wall thickening (8/8, 100%), and pleural effusions (4/8, 50%). These findings of acute lung injury, including diffuse alveolar damage, organizing pneumonia and bronchiolitis were consistent with the histopathological findings recently reported by Mukhopadhyay and Butt (2,3). Radiographic findings demonstrated the presence of patchy consolidations and ground-glass opacifications in the earlier phase of disease, and the persistence of ill-defined centrilobular nodular opacifications, and the development of reticulations with traction bronchiectasis in the later phase. These radiographic patterns should be utilized in the setting of unexplained dyspnea and respiratory failure for early diagnosis and treatment of EVALI. A consistent pathologic finding was the presence of small, fine intracytoplasmic vacuoles within the foamy macrophages consistent with an endogenous source of lipids. These foamy macrophages are commonly associated with an obstructive pathology, such as small airway diseases or bronchiolitis that may present with a diffuse infiltrative pneumonia. The presence of lipid-laden macrophages should be seen as a pathological entity, and in the appropriate clinical scenario may be utilized as a sign of exposure in EVALI. CONCLUSIONS: This case series presented novel patterns of EVALI that were concerning for both alveolar damage and bronchiolar destruction. These patterns, included diffuse alveolar damage, organizing pneumonia and bronchiolitis. It also raised concerns for potential complications of EVALI, such as the development of bronchiectasis and obstructive lung diseases. We encourage physicians to discourage the use of e-cigarette products in these patients, and to maintain close follow-up for monitoring of long term sequelae of disease. Reference #1: CDC. (2020). Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html Reference #2: Mukhopadhyay, S., Mehrad, M., Dammert, P., Arrossi, A. V., Sarda, R., Brenner, D. S., ... & Ghobrial, M. (2019). Lung Biopsy Findings in Severe Pulmonary Illness Associated With E-Cigarette Use (Vaping). American journal of clinical pathology. Reference #3: Butt, Y. M., Smith, M. L., Tazelaar, H. D., Vaszar, L. T., Swanson, K. L., Cecchini, M. J., ... & Khoor, A. (2019). Pathology of vaping-associated lung injury. New England journal of medicine, 381(18), 1780-1781. DISCLOSURES: No relevant relationships by Patrick Baghdasaryan, source=Web Response No relevant relationships by Twinkle Chandak, source=Web Response No relevant relationships by Tim Cheng, source=Web Response No relevant relationships by Matthew Crabtree, source=Web Response Industry Sponsored Research Trial relationship with PulmonX Please note: $5001 - $20000 Added 04/13/2020 by David Hsia, source=Web Response, value=Grant/Research Support Removed 04/13/2020 by David Hsia, source=Web Response Industry Sponsored Research Trial relationship with PulmonX Please note: $1001 - $5000 Added 04/13/2020 by David Hsia, source=Web Response, value=Grant/Research Support No relevant relationships by Thomas Jiang, source=Web Response No relevant relationships by Madlena Nalbandian, source=Web Response No relevant relationships by Janine Vintch, source=Web Response No relevant relationships by Fady Youssef, source=Web Response

Flexible Bronchoscopy in Evaluation of Persistent Wheezing in Children-Experiences from National Pediatric Center.

Background and objectives: Persistent wheezing (PW) is defined as prolonged or recurrent episodes of wheezing despite regular treatment. Flexible bronchoscopy (FB) is recommended to determine the etiology of PW in children. This study aimed to determine the etiology of PW based on FB findings in a national pediatric center. Materials and Methods: Children presenting with PW that underwent flexible bronchoscopy from April 2016 to August 2019 at the Mother and Child Health Institute of Serbia were included in this observational study. After endoscopic evaluation, bronchoalveolar lavage fluid (BALF) samples were taken and further analyzed. Quantitative microbiology, cytological analysis and oil-red staining of specimens were performed to determine cellular constituents and presence of lipid laden macrophages (LLM). Upper gastrointestinal series were performed to exclude gastroesophageal reflux disease, swallowing dysfunction and vascular ring. Results: Pathological findings were revealed in 151 of 172 study participants, with bacterial lower airway infection (BLAI) (48.3%) and primary bronchomalacia (20.4%) as the most common. Younger participants were hospitalized for significantly longer periods (ρ = −0.366, p < 0.001). Study participants with BLAI and associated mucus plugging were notably younger (p < 0.001). Presence of LLM in BALF was not associated with findings of upper gastrointestinal series. All patients with confirmed BLAI were treated with oral antibiotics. Although FB is considered to be invasive, there were no complications associated with the procedure. Conclusions: Flexible bronchoscopy has an exceptional diagnostic value in evaluation of PW. In younger patients with BLAI, presence of mucus plugs may complicate the clinical course, so significant benefits can be achieved with therapeutic lavage during bronchoscopy.

Xanthogranulomatous salpingitis and its association with endometriosis: A case report and review of the literature

A case of xanthogranulomatous salpingitis is presented in a 36-year-old woman with a longstanding history of chronic pelvic pain on a background of endometriosis. The presentation of endometriosis in this case is that of hemorrhagic ascites which is a rare occurrence. Xanthogranulomatous salpingitis is a rare form of chronic inflammation involving the fallopian tube, and it is characterized by the presence of lipid-laden macrophages and other chronic inflammatory cells within the wall of the fallopian tube. There are only a few cases of xanthogranulomatous inflammation affecting the female genital tract which are reported in the medical literature.

Prevalence of Pediatric Aspiration-Associated Extraesophageal Reflux Disease

The role of aspiration-associated extraesophageal reflux disease (AERD) in patients with chronic respiratory symptoms is not well defined. Identifying the frequency of AERD in these patients may provide guidance in their treatment. To determine the prevalence of AERD in patients with chronic respiratory symptoms and to assess the utility of pepsin as a new marker for AERD. Case-control study performed from 2008 through 2012.Western blot analysis for pepsin and oil red O staining for lipid-laden macrophages (LLMs) was performed on bronchoalveolar lavage fluid specimens. Tertiary referral center. Sixty-five patients (aged 4.5 months to 24 years) with chronic pulmonary disease, with or without tracheostomy, were compared with controls undergoing elective surgery who had no history of pulmonary disease. Presence of pepsin and LLMs and quantity of LLMs in specimens. Seventy-six total patients participated: 34 patients who underwent bronchoscopy, 31 patients with tracheostomy, and 11 controls. Pepsin-positive bronchoalveolar lavage fluid specimens were identified in 25 patients who underwent bronchoscopy (74%) and 22 patients with tracheostomy (71%). All specimens from controls were negative for pepsin. Presence of LLMs was identified in specimens from 31 patients in the bronchoscopy group (91%), 16 patients in the tracheostomy group (52%), and 7 controls (64%), with a similar distribution of the quantity of LLMs in each lavage fluid specimen among the groups. Patients with chronic pulmonary disease have a high prevalence of AERD, which may have important treatment implications. The presence of pepsin was a better predictor of AERD in patients with respiratory symptoms compared with controls than presence of LLMs. Detection of pepsin in bronchoalveolar lavage fluid specimens can serve as a biomarker for AERD and is potentially superior to the current method of measuring LLMs. Whereas there is a significant association between AERD and the presence of chronic respiratory symptoms, this study does not verify causation. Additional study investigating the mechanism of pepsin on the respiratory epithelium may further our understanding of the pathophysiologic characteristics of this association and provide additional management options for these patients.

Ontogenic changes in lung cholesterol metabolism, lipid content, and histology in mice with Niemann–Pick type C disease

Niemann–Pick Type C (NPC) disease is caused by a deficiency of either NPC1 or NPC2. Loss of function of either protein results in the progressive accumulation of unesterified cholesterol in every tissue leading to cell death and organ damage. Most literature on NPC disease focuses on neurological and liver manifestations. Pulmonary dysfunction is less well described. The present studies investigated how Npc1 deficiency impacts the absolute weight, lipid composition and histology of the lungs of Npc1−/− mice (Npc1nih) at different stages of the disease, and also quantitated changes in the rates of cholesterol and fatty acid synthesis in the lung over this same time span (8 to 70days of age). Similar measurements were made in Npc2−/− mice at 70days. All mice were of the BALB/c strain and were fed a basal rodent chow diet. Well before weaning, the lung weight, cholesterol and phospholipid (PL) content, and cholesterol synthesis rate were all elevated in the Npc1−/− mice and remained so at 70days of age. In contrast, lung triacylglycerol content was reduced while there was no change in lung fatty acid synthesis. Despite the elevated PL content, the composition of PL in the lungs of the Npc1−/− mice was unchanged. H&E staining revealed an age-related increase in the presence of lipid-laden macrophages in the alveoli of the lungs of the Npc1−/− mice starting as early as 28days. Similar metabolic and histologic changes were evident in the lungs of the Npc2−/− mice. Together these findings demonstrate an intrinsic lung pathology in NPC disease that is of early onset and worsens over time.

Lipoid Pneumonia—A Case of Refractory Pneumonia in a Child Treated with Ketogenic Diet

Lipoid pneumonia (LP) is a chronic inflammation of the lung parenchyma with interstitial involvement due to the accumulation of endogenous or exogenous lipids. Exogenous LP (ELP) is associated with the aspiration or inhalation of oil present in food, oil-based medications or radiographic contrast media. The clinical manifestations of LP range from asymptomatic cases to severe pulmonary involvement, with respiratory failure and death, according to the quantity and duration of the aspiration. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil and the presence of lipid-laden macrophages on sputum or bronchoalveolar lavage (BAL) analysis. High-resolution computed tomography (HRCT) is the imaging technique of choice for evaluation of patients with suspected LP. The best therapeutic strategy is to remove the oil as early as possible through bronchoscopy with multiple BALs and interruption in the use of mineral oil. Steroid therapy remains controversial, and should be reserved for severe cases. We describe a case of LP due to oil aspiration in 3-year-old girl with intractable epilepsy on ketogenic diet. Diagnostic problems were due to non-specific symptoms that were mimicking serious infectious pneumonia. A high index of suspicion and precise medical history is required in cases of refractory pneumonia and fever unresponsive to conventional therapy. Gastroesophageal reflux and a risk of aspiration may be regarded as relative contraindications to the ketogenic diet. Conservative treatment, based on the use of oral steroids, proved to be an efficient therapeutic approach in this case.

Do Not Play with Fire

We report a case of exogenous lipoid pneumonia caused by inhalation of liquid paraffin in a fire eater young man. The patient was admitted to the Emergency Department because of acute retrosternal pain, dry cough and dyspnea. Chest radiograph showed multiple bilateral basal alveolar opacities associated to left pleural effusion; CT chest scan showed multiple bilateral areas of consolidation with cavity areas. BAL cytologic examination revealed abundant lipid-laden macrophages. Clinical symptoms resolved after corticosteroid treatment. Lipoid pneumonia is a rare and often underdiagnosed entity. The presence of lipid-laden macrophages in sputum or BAL fluid helps to confirm the diagnosis.

Egzogenne tłuszczowe zapalenie płuc u połykacza ognia-opis przypadku

Exogenous lipoid pneumonia is an uncommon condition caused by inhalation or aspiration of a fatty substance. It usually presents as chronic respiratory illness mimicking interstitial lung diseases. Acute exogenous lipoid pneumonia is uncommon and typically is caused by an episode of aspiration of a large quantity of a petroleum-based product. Radiological findings vary and may imitate many other diseases. We present a rare case of acute exogenous lipoid pneumonia in a fire-eater who aspirated liquid paraffin during his flame-blowing show (fire-eater's lung). He was admitted to the hospital with productive cough, fever, hemoptysis, chest pain and dyspnea. Diagnosis was made on the basis of history of exposure to fatty substance, characteristic findings in CT examination and presence of lipid-laden macrophages in bronchoalveolar lavage fluid. Acute exogenous lipoid pneumonia is a very rare disease that typically occurs in fire-eaters and is called a fire-eater's lung. The diagnosis is made on the basis of typical history and radiological, as well as histopathological findings.

The Effect of Passive Cigarette Smoke Exposure on the Presence of Lipid-Laden Macrophages in Bronchoalveolar Lavage Fluid Obtained by Fiber-optic Bronchoscopy in Pediatric Patients

PURPOSE: It is well documented that passive smoke exposure exacerbates asthma in children. The purpose of the study was to determine a correlation between passive smoke exposure (PSE) in children and the presence of lipid laden macrophages (LLM), a marker of inflammation and aspiration, in bronchoalveolar lavage (BAL) fluid obtained during fiberoptic bronchoscopy (FOB).

CT Findings in Hydrocarbon Pneumonitis After Diesel Fuel Siphonage

The purpose of this study was to assess CT findings in a series of patients with hydrocarbon pneumonitis after diesel fuel siphonage. The characteristic CT findings of hydrocarbon pneumonitis after diesel fuel siphonage are the presence of air-space consolidations with predominant right middle lobe involvement and areas of low attenuation within consolidation. Occasionally, bronchoalveolar lavage is needed to confirm the diagnosis of hydrocarbon pneumonitis by the presence of lipid-laden macrophages on the basis of a history of diesel fuel aspiration.

Uncommon synchronous histopathological features of a radicular cyst: a case report.

Radicular cysts are the most common inflammatory odontogenic cystic lesions. It originates from epithelial residues in periodontal ligaments secondary to inflammation. The pathogenesis involves the activation of epithelial cell rests of Malaseez after physical, chemical or bacterial injury. Microscopically, the cyst is thin with smooth or corrugated inner surface. The most common epithelial lining is stratified squamous; with Rushton's hyaline bodies in 10% of the reported cases. Slow accumulation and deposition of cholesterol during the inflammatory process leads to the formation of "clefts" with acute and chronic inflammatory cells in the proliferating epithelium and connective tissue, respectively. The presence of hemosiderin usually indicates a previous micro-hemorrhage event. While the presence of lipid-laden macrophages or foam cells indicate the presence of cholesterol-removing mechanism from the lesion. We report a rare case of 38-year-old Mediterranean female presented with throbbing right maxillary pain. The diagnosis of radicular cyst was confirmed by the presence of atrophic non-keratinized stratified squamous epithelium. The radicular cyst was associated with hemosiderin, foam cells, subepithelial fibrosis and root canal dystrophic calcification. They represent uncommon synchronous histopathological features.

Uncommon synchronous histopathological features of a radicular cyst: a case report

Radicular cysts are the most common inflammatory odontogenic cystic lesions. It originates from epithelial residues in periodontal ligaments secondary to inflammation. The pathogenesis involves the activation of epithelial cell rests of Malaseez after physical, chemical or bacterial injury. Microscopically, the cyst is thin with smooth or corrugated inner surface. The most common epithelial lining is stratified squamous; with Rushton's hyaline bodies in 10% of the reported cases. Slow accumulation and deposition of cholesterol during the inflammatory process leads to the formation of "clefts" with acute and chronic inflammatory cells in the proliferating epithelium and connective tissue, respectively. The presence of hemosiderin usually indicates a previous micro-hemorrhage event. While the presence of lipid-laden macrophages or foam cells indicate the presence of cholesterol-removing mechanism from the lesion. We report a rare case of 38-year-old Mediterranean female presented with throbbing right maxillary pain. The diagnosis of radicular cyst was confirmed by the presence of atrophic non-keratinized stratified squamous epithelium. The radicular cyst was associated with hemosiderin, foam cells, subepithelial fibrosis and root canal dystrophic calcification. They represent uncommon synchronous histopathological features.

Is There a Relationship between Airway Variants and the Lipid Laden Macrophage Index?

Patients with anatomic airway abnormalities have been found to have a higher incidence of gastroesophageal reflux and are presumably at risk for pulmonary aspiration which could be determined by the presence of Lipid Laden Macrophages (LLM) in bronchoalveolar lavage fluid (BALF). We propose that the LLM Index will be higher in those such patients in comparison to the control group.

Characterization of foam cell formation in human macrophage subsets (95.17)

Abstract The hallmark of the human atherosclerotic plaque is the presence of lipid-laden macrophages, or foam cells. However, many macrophage subsets are found within atherosclerotic lesions and it is not well understood how monocytes differentiate into these subsets. We focused on characterizing macrophages derived in vitro from human peripheral blood monocytes treated with IL-15, IL-4 or IL-10. We show these macrophages to have differing phenotypes: CD209+CD64+, CD209+CD23+, or CD209+CD163+ for macrophages derived from IL-15, IL-4, or IL-10 respectively. To characterize the macrophage subsets ability to become foam cells we measured their uptake of fluorescently-labeled oxidized LDL (oxLDL). IL-10 derived macrophages had the greatest amount of oxLDL uptake. We then investigated the mechanism of uptake and found that fucoidan, a class-A scavenger receptor competitor, significantly inhibited uptake of oxLDL in IL-10 cells. On the other hand a blocking antibody against the class B scavenger receptor, CD36, did not inhibit uptake. Furthermore, we found IL-10 macrophages to express higher mRNA levels of the class A scavenger receptors macrophage receptor with collagenous structure (MARCO) and macrophage scavenger receptor (MSR) expression. These data suggests that IL-10 may promote foam cell formation and is dependent on class-A, but not class B scavenger receptors.

Plasma chitotriosidase in male Fabry patients: A marker for monitoring lipid-laden macrophages and their correction by enzyme replacement therapy

Increased plasma chitotriosidase is a well established surrogate marker for the occurrence of lipid-laden macrophages in the glycosphingolipidosis Gaucher disease. The complete lack of surrogate markers for Fabry disease, X-linked globotriaosylceramidosis stemming from deficiency in the lysosomal α-galactosidase A (AGA), prompted us to study chitotriosidase in this disorder. In male Fabry patients plasma chitotriosidase is significantly elevated, consistent with the presence of lipid-laden macrophages in several tissues. Increased levels are detectable at very young age and precede clinical manifestations. No strict correlation exists with severity of disease manifestations. Upon therapy with either of the two available recombinant AGA preparations, plasma chitotriosidase levels are nicely normalized in male Fabry patients. However, in patients developing neutralizing antibodies towards AGA, reduction in plasma chitotriosidase is hampered. In sharp contrast to the situation in male patients, females heterozygous for AGA deficiency show no significantly elevated plasma chitotriosidase. This suggests that circulating endogenous AGA in heterozygotes is sufficient to supplement enzyme-deficient macrophages. In conclusion, for the first time a biological marker for lipid-laden cells in Fabry patients is demonstrated; elevated plasma chitotriosidase levels reflecting lipid-laden macrophages. Corrections in this marker illustrate the efficacy of enzyme replacement therapy in clearing the lipid accumulation in this particular cell type.