Reactive Hyperplasia Research Articles

Reversible role of MIR654/3P and MIR9/3P in pathogenesis of Epstein-Barr Virus negative, but not positive, Burkitt's lymphoma.

The role of MIR654 in Burkitt's lymphoma (BL) and whether it impacts expression of MYC, and its downstream activated MIR9 is not known. Expression of MYC, MYCN, MYCL, MIR9/3P, MIR654/5P, and MIR654/3P were assessed by qRT-PCR in biopsy samples from Epstein-Barr virus (EBV)- and EBV+ BL patients and BL cell lines. Effects of modulation of MIR9/3P and MIR654/3P on cell proliferation, apoptosis and chemosensitivity were evaluated. Luciferase reporter assay was performed to validate putative target of MIR654/5P. Effects of MIR9/3P and MIR654/3P on tumor burden and disease outcome were evaluated using xenograft model of BL. Expression of MYC, MYCN, and MIR9/3P was higher in all BL patient samples and cell lines. Expression of MIR654/3P was downregulated in EBV- BL patient samples and cell lines compared to either noncancer lymphoid reactive hyperplasia (LRH) or EBV+ samples and cell lines. Additionally, MIR654/3P overexpression inhibited cell proliferation, induced apoptosis, and increased chemosensitivity in EBV- BL cell lines. Luciferase reporter assay confirmed that MYC is a target of MIR654/3P in both EBV- and EBV+ BL cell lines; however, the effect of MIR654/3P-mediated targeting of MYC is overridden in EBV+ cells. Administration of MIR654/3P mimic or MIR9/3P antagomir in the xenograft model decreased tumor burden and increased survival. Combined intervention with MIR654/3P mimic and MIR9/3P antagomir had synergistic action on decreasing tumor burden and improving disease outcome. MIR654/3P, as a putative tumor suppressor in EBV- BL, collaborated MIR9/3P might serve as a therapeutic agent to treat EBV- BL patients in combination with existing chemotherapy and immunotherapy regimes.

Clonal Bronchopulmonary B-Cell Proliferations of Indeterminate Malignant Potential in Patients with Common Variable Immune Deficiency (CVID) associated Granulomatous Lymphocytic Interstitial Lung Disease (GLILD)

Abstract Introduction/Objective Pulmonary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is often challenging to distinguish from reactive nodular lymphoid hyperplasia, and assessing B-cell clonality in such cases is crucial in making the distinction. However, patients with common variable immune deficiency (CVID) can harbor clonal or oligoclonal lymphoid populations in their tissues, particularly in association with granulomatous lymphocytic interstitial lung disease (GLILD), making the distinction from MALT lymphoma extremely challenging. We report six cases of GLILD with clonal or oligoclonal B cell infiltrates in lung wedge resection specimens and describe their clinicopathologic characteristics, management, and outcomes. Methods/Case Report A retrospective review was performed to collect lung wedge resection specimens from patients with CVID showing atypical B-cell infiltrates associated with GLILD between 01/2015 and 08/2023. The clinicopathologic findings, management, and response to treatment were studied. Results (if a Case Study enter NA) A total of six GLILD cases were identified with variable degrees of architectural and cytologic lymphoid atypia. Clonality of the lymphoid infiltrate was assessed by kappa/lambda in situ hybridization staining in all six, flow cytometry in 3/6, and IGH gene rearrangement in 4/6 cases. The infiltrate showed frank lambda restriction in 1/6, lambda predominance in 1/6, polytypic expression in 1/6, and no significant plasmacytic component in 3/6 cases. Flow cytometry detected atypical light chain skewed B-cell populations in 3/3 of cases. IGH was positive for clonality in 3/4 and oligoclonal in 1/4 cases. Four patients received therapeutic intervention for GLILD, including one with Rituximab monotherapy, two with Rituximab+Azathioprine, and one with Rituximab+Mycophenolate leading to marked symptomatic and radiologic improvement in all four patients. The remaining two patients were observed to have stable disease. Conclusion Patients with CVID can harbor clonal B-cell populations due to their underlying immune dysfunction. Studies have shown that these can be transient and may not always progress to overt lymphoma. In the setting of GLILD, detecting these populations makes the distinction from MALT lymphoma very challenging. Given that the first- line therapy for both GLILD and MALT is anti-CD20 therapy, the malignant potential of these clones remains uncertain and can only be determined with long-term clinical follow-up.

Traumatic Fibroma : A Case Report

Fibroma is a benign fibrous tissue growth that develops as reactive hyperplasia to trauma or local irritation. It is usually characterized by slow growing, painless, firm, nodular mass merging with the colour of surrounding tissue. It is mainly seen in the region of buccal mucosa, along the plane of occlusion of maxillary and mandibular teeth, tongue, gingiva and hard palate. On clinical examination it resembles pyogenic granuloma, peripheral giant cell granuloma.

An Unusual Lesion in the Ileocecal Area: Reactive Hyperplasia of Blood Vessels

An Unusual Lesion in the Ileocecal Area: Reactive Hyperplasia of Blood Vessels

A case report of immune checkpoint inhibitor-related adverse reactions predominantly manifests as tumor-type reactive cutaneous capillary endothelial hyperplasia

A case report of immune checkpoint inhibitor-related adverse reactions predominantly manifests as tumor-type reactive cutaneous capillary endothelial hyperplasia

Normative Measurements of the Infraorbital Nerve by Magnetic Resonance Imaging in an Australia Cohort.

To report the normative dimensions of the infraorbital nerve on fat-suppressed gadolinium-enhanced MRI and correlate with patient demographics in an Australian cohort. A retrospective review of patients who underwent coronal fat-suppressed gadolinium T1-weighted MRI from September 2021 to December 2023. One hundred sixty-eight orbits were included. The maximum diameter of the infraorbital nerve and the optic nerve sheath was measured. Orbits were excluded if there was unilateral or bilateral pathology of the infraorbital nerve or optic nerve sheath, incomplete MRI sequences, poor image quality, or indiscernible infraorbital nerve on radiological examination. The mean age of participants was 58 ± 16 years, and 50% were females (n = 42). The mean normative measurements (mean ± standard deviation) on coronal T1-weighted imaging: optic nerve sheath, 5.08 ± 0.67 mm. On coronal fat-suppressed gadolinium T1-weighted imaging: infraorbital nerve, 0.89 ± 0.22mm. No significant differences were found between male or female participants in both the infraorbital nerve (p = 0.757) or optic nerve sheath (p = 0.646). There was no significant correlation between age and mean diameter of the infraorbital nerve (r = 0.077, p = 0.320) or optic nerve sheath (r = 0.075, p = 0.336). Additionally, no significant difference was identified between the mean diameter of the infraorbital nerve (p = 0.079) and optic nerve sheath (p = 0.120) across age groups. The mean infraorbital nerve to optic nerve sheath ratio was 0.18 ± 0.00. Normative dimensions of the infraorbital nerve may be used to identify enlargement in conditions such as IgG4-related ophthalmic disease and reactive lymphoid hyperplasia.

The Importance of Diagnostic Mediastinoscopy in Patients with Mediastinal Lymphadenopathy

Objectives: Mediastinoscopy is a safe and invasive diagnostic method allowing to obtain sufficient tissue samples in the diagnosis of many malignant and benign intrathoracic diseases. In this study, it was aimed to determine the importance of mediastinoscopy in diagnosing mediastinal diseases and also provide patient data in the resolution of mediastinal diseases. Methods: Between January 2016 and December 2020, 76 cases of mediastinal lymphadenopathy that could not be diagnosed by other diagnostic methods were evaluated. Results: 64 (84,2%) of these 76 cases were diagnosed by mediastinoscopy. 12 cases (15.7%) were reported as reactive lymphoid hyperplasia. Since the definitive diagnosis of these cases could not be proven, they were considered as false-negative. Histopathological examination revealed chronic granulomatous lymphadenitis in 16 cases, non-necrotizing granulomatous lymphadenitis in 27 cases, metastasis of malignant disease in 18 cases, and lymphoma in 2 cases. In our study, the sensitivity of mediastinoscopy was determined as 84.2%. Neither mortality nor morbidity was detected in our cases. Conclusion: As a result, mediastinoscopy continues to maintain its traditional place for patients that cannot be diagnosed, because it is reliable and less invasive.

Clinicopathological features of metastatic melanoma in effusion cytology of serosal cavity

Objective: To investigate the clinical, cytomorphology, immunocytochemical and molecular features of metastatic melanoma in serosal cavity effusion. Methods: Cytological specimens of 14 patients with melanoma in the chest and abdomen were collected from 2017 to 2023, at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. SOX10, S-100 protein, PRAME, BRAF V600E, HMB45, and Melan A were detected by immunocytochemical methods. Fourteen cases were tested for routine antibody combinations, including Claudin4, HEG1, Calretinin, CD68, etc. Four of the patients had biopsy or surgical samples of metastatic solid lesions of primary sites, and further next-generation sequencing (NGS) or amplification refractory mutation system (ARMS)-PCR molecular test was performed. In addition, 30 cases of serosal effusion samples were collected as control groups (10 cases of benign mesothelial cell reactive hyperplasia, 10 cases of mesothelioma, and 10 cases of metastatic lung adenocarcinoma). Results: Among the 14 cases of melanoma, there were 7 males and 7 females, with ages ranging from 35 to 86 years, and an average age of 57 years, there 10 cases aged ≥50 years. The tumor cells in the serosal effusion varied in morphology and degree of atypia. SOX10 was positive in all 14 cases (14/14), S-100 protein was positive in 10 cases (10/14), PRAME was positive in 12 cases (12/14), BRAF V600E was positive in 10 cases (10/14), HMB45 was positive in 12 cases (12/14), and Melan A was positive in 13 cases (13/14). In 4 patients with histological correlation, the cytological and histological expression of SOX10, BRAF V600E, and PRAME was positive in all 4 cases (4/4); S-100 protein was positive in 2 cases (2/4); and HMB45 and Melan A were positive in 3 cases (3/4). Using NGS or ARMS-PCR, missense mutations of BRAF V600E were detected in all 4 patients; TERT promoter mutations was detected in 1 case; and CDKN2A terminating mutations and MSI1 deletion mutations were detected in the other case. SOX10, S-100, HMB45, Melan A, PRAME and BRAF V600E were all negative in 30 control samples of serosal cavity effusion. Conclusion: By observing the morphology of tumor cells, immunocytochemical test of several combination markers, especially the expression of SOX10, BRAF V600E and PRAME, can help to improve the positive diagnosis rate of melanoma in serous cavity effusion.

Etiological Spectrum of Lymphadenopathy Among Children on Lymph Node Biopsy.

Background Pediatric peripheral lymphadenopathy is commonly a benign condition and most cases resolve spontaneously; however, it can be a manifestation of a serious underlying disease. This study aimed to determine the etiological spectrum of persistent pediatric lymphadenopathy on excisional biopsy in a tertiary care children's hospital in a low-middle-income country and to make recommendations regarding evaluation, diagnostic testing, and surgical interventions best suited to the population. Methodology A prospective cross-sectionalstudy was conducted on 243 pediatric patients between the ages of one to 12 years undergoing excisional biopsy for persistent lymphadenopathy (more than four weeks duration) from April 1, 2021, to March 31, 2024. Patient demographic data along with signs, symptoms, and results of investigations including histopathological diagnosis were documented on a structured proforma. Results Patients' age range was two to 12 years (mean = 7.29 ± 2.30 years). The male-to-female ratio was 1:53. The Mean duration of lymphadenopathy was 35.89 ± 6.95 days (range = 25 to 57 days). The average size of lymph nodes ranged from 1 cm to a complex nodal mass of 7 cm. Histopathology showed reactive hyperplasia (40.32%, n = 98), tuberculosis (TB) (33.7%, n = 82), lymphoma (10.3%, n = 25), atypical mycobacterial adenitis (6.99%, n = 17), chronic granulomatous inflammation-histiocytosis (6.2%, n = 15), and Langerhans cell histiocytosis (2.5%, n = 6). The most common site was cervical. Sputum GeneXpert for TB had a true-positive rate of 78.84% while PPD was positive in only 13 TB patients. Atypical mycobacterial adenitis was successfully treated with excision and antibiotics. Supraclavicular nodes were strongly associated with lymphoma (p = 0.008). Conclusions Persistent pediatric lymphadenopathy is most commonly caused by TB followed by lymphoma. Positive sputum GeneXpert for TB with a suggestive clinical picture in endemic regions may be sufficient to start empiric therapy without the need for excisional biopsy in mycobacterial TB adenitis with negative PPD results and normal chest X-ray. In all other cases, excisional biopsy remains the gold standard for diagnosis. However, further studies should be conducted to formulate less invasive management algorithms.

Clinical prediction model for pediatric lymphadenopathy: enhancing diagnostic precision and treatment decision making.

Lymph node enlargement is common in children, with 90% of physiologically palpable lymph nodes. This study aimed to develop a predictive model based on clinical characteristics to enhance the diagnosis of pediatric lymphadenopathy and provide insights into biopsy outcomes. A clinical prediction rule was developed using a retrospective, cross-sectional design for patients under 15years who underwent lymph node biopsy from 2012 to 2022. Multivariable risk regression was used to analyze benign and malignant lesions, presenting results through risk difference and AUROC for each group. Predicted probabilities were applied in a logistic regression equation to classify patients' lymphadenopathy as reactive hyperplasia, benign, or malignant. Of 188 children, 70 (37.2%) had benign lymphadenopathy beyond reactive hyperplasia, and 27 (14.4%) had malignant lymphadenopathy. The predictive model included 12 characteristics such as size, location, duration, associated symptoms, and lymph node examination. Predictive accuracy was 92.2% for benign cases (AUROC = 0.92; 95% CI 0.87-0.96) and 98.6% for malignancy (AUROC = 0.98; 95% CI 0.94-0.99). Overall accuracy for predicting both benign and malignant tumors was 68.3%. The model demonstrated reasonably accurate predictions for the clinical characteristics of pediatric lymphadenopathy. It tended to overestimate malignancy but did not miss diagnoses, aiding in reducing unnecessary lymph node biopsies in benign cases.

Combined detection of SHOX2 and PTGER4 methylation with serum marker CYFRA21-1 for improved diagnosis of malignant pleural mesothelioma

AimsTo investigate the performance of a combined biomarker approach using the methylation status of the short stature homeobox 2 (SHOX2) and prostaglandin E2 receptor EP4 (PTGER4) genes, along with the...

Clinicopathological Spectrum of Head and Neck Lesions By FNAC at a Tertiary Care Centre in Barpeta, Assam – A Retrospective Study

Background: Various neoplastic and non-neoplastic lesions arising from lymph nodes, salivary glands, thyroid gland, soft tissue and metastatic deposits comprises the wide spectrum of lesions in the head & neck region. The Foundation of Head and Neck Cancer (FHNC) helps in differentiating non-neoplastic lesions from neoplastic and further from benign and malignant lesions. The aim of this study was to evaluate the role and diagnostic accuracy of FNAC in diagnosis of palpable head and neck lesions. Materials and methods: A total of 360 cases were included in the study. Out of the 360 cases, 122 (33.89%) cases were sent for histopathological examination and the results were correlated histologically. Aspirations were done by using 10 ml syringe and 22/23-gauge needles. Smears were stained with May Grunwald Giemsa (MGG). Cytomorphological diagnosis was given. Results: Out of 360 patients of head and neck lesions studied, lymph node (40.56%) was the predominant site aspirated with reactive lymphoid hyperplasia being the commonest lesion. Soft tissue constitutes 31.11% cases followed by thyroid lesions with 19.72% cases, salivary gland 7.22% cases, and oral cavity 1.39% cases. FNAC was inconclusive in 4.17% cases. Conclusion: Head and neck lesions are common lesions located superficially that can be easily diagnosed on cytology. Although excisional biopsy is the gold standard for diagnosing head and neck malignant lesions, FNAC plays a vital role as a quick and inexpensive diagnostic procedure with high diagnostic accuracy. It distinguishes between inflammatory/infection and neoplastic lesions, avoiding needless procedures and expediting therapy. FNAC is a low-cost, accurate diagnostic method that may be used as a first-line examination.

Primary immune‐mediated neutropenia and precursor‐targeted immune‐mediated anaemia in a 4‐year‐old cat

AbstractA 4‐year‐old, female, neutered, domestic shorthair was presented for acute onset of lethargy. The cat had been diagnosed with and treated for precursor‐targeted immune‐mediated anaemia 2 years before presentation. The clinical examination was unremarkable. Haematology and biochemistry revealed neutropenia and hyperglobulinaemia. Electrophoresis revealed polyclonal gammopathy. Toxoplasma spp. IgG/IgM, Bartonella spp., feline immunodeficiency virus and feline leukaemia virus serology were negative. Urine culture was negative. A computed tomography scan of the thorax and abdomen revealed an enlarged spleen, and cytology was suggestive of reactive lymphoid hyperplasia. Bone marrow aspirates and biopsies were supportive of primary immune‐mediated neutropenia and recurrence of precursor‐targeted immune‐mediated anaemia. The cat was treated successfully with prednisolone and cyclosporine. The necessity to perform a bone marrow biopsy should be highlighted in this case, as the diagnosis of precursor‐targeted immune‐mediated anaemia and immune‐mediated neutropenia was based on bone marrow sampling, exclusion of infectious disorders and response to immunosuppressive medications.

Clinicopathologic features and outcomes of bilateral lacrimal gland lesions.

The present study reviewed the clinicopathological features and outcomes of bilateral lacrimal gland lesions. The data of 113 patients who underwent lacrimal gland biopsy at the West China Hospital of Sichuan University, China, between January 1, 2010, and December 31, 2021, are presented in this case series. The patients all presented with bilateral lacrimal gland lesions. The collected data included patient demographics, clinical features, the results of laboratory examinations, imaging presentations, histopathological diagnoses, treatments, and outcomes. The mean age of the 113 enrolled patients was 47.4 ± 14.9 years (range, 11-77 years) with a predominance of females (54.9%, n = 62). The lacrimal gland was the source of the majority of biopsy tissue (98.2%, n = 111). The most prevalent etiology was immunoglobulin G4-related ophthalmic disease (IgG4-ROD) (32.7%, n = 37), followed by idiopathic orbital inflammation (IOI) (28.3%, n = 32), mucosa-associated lymphoid tissue (MALT) lymphoma (17.7%, n = 20), reactive lymphoid hyperplasia (RLH) (10.6%, n = 12), and mantle cell lymphoma (4.4%, n = 5). Patients with IOI were significantly younger than those with IgG4-ROD and MALT lymphoma (t = 2.932, P = 0.005; t = 3.865, P<0.001, respectively). Systemic symptoms were more prevalent among patients with IgG4-ROD (χ2 = 7.916, P = 0.005). The majority of patients were treated with surgery (53.1%, n = 60), with surgery combined with corticosteroid therapy (21.2%, n = 24) being the second most common treatment. The majority of patients (91.2%, n = 103) attained complete resolution, stable disease, or significant improvement. In conclusion, there are several aetiologies associated with bilateral lacrimal gland lesions, the most prevalent being IgG4-ROD, IOI, and MALT lymphoma. Systemic symptoms were more common in patients with IgG4-ROD. The majority of patients who presented with bilateral lesions of the lacrimal glands responded satisfactorily to treatment, with favorable results.

Histomorphological Patterns of Lesions in Lymph Node Biopsies in a Tertiary Care Hospital

Background: Lymphadenopathy is one of the most common presentations of inflammatory and neoplastic disorders. Detailed assessment is required to reveal an underlying pathology. Clinical features along with radiology images may not be sufficient for diagnosis of lymph node enlargement. Hence, lymph node biopsy has become a mandatory tool to arrive at a definitive diagnosis. Methods: This cross-sectional retrospective study was conducted in the Department of Pathology, Rajshahi Medical College over a period of one year from July 2022 to June 2023. A total of 130 cases of lymph node biopsies were included in this study as the study subjects purposively. Specimen of tissue was fixed with 10% formalin and stained with haematoxyline and eosin stain, followed by histopathological examination. Statistical analysis was performed using Microsoft Excel. Result: A total of 130 lymph node biopsies were studied with ages ranging from 13 to 72 years. Most of the cases (54%) belonged to 21-40 years. Female patients were 52% and male patients were 48%. Reactive hyperplasia was the commonest lesion accounting for 37% of cases (48 cases), followed by metastatic deposits showed in 36 cases (28%).Reactive hyperplasia was common in early age group while 69% of metastatic deposits were found in age group above 40 years. Duct cell carcinoma was the commonest metastatic carcinoma (42%) in this present study. Conclusion: To establish the causes of lymphadenopathy, lymph node biopsy plays an important role. It is less expensive than other tests when investigating the cause of enlarged lymph nodes.

Using T2-weighted magnetic resonance imaging-derived radiomics to classify cervical lymphadenopathy in children

BackgroundCervical lymphadenopathy is common in children and has diverse causes varying from benign to malignant, their similar manifestations making differential diagnosis difficult.ObjectiveThis study aimed to investigate whether radiomic models using conventional magnetic resonance imaging (MRI) could classify pediatric cervical lymphadenopathy.MethodsA total of 419 cervical lymph nodes from 146 patients, and encompassing four common etiologies (Kikuchi disease, reactive hyperplasia, suppurative lymphadenitis and malignancy), were randomly divided into training and testing sets in a ratio of 7:3. For each lymph node, 1,218 features were extracted from T2-weighted images. Then, the least absolute shrinkage and selection operator (LASSO) models were used to select the most relevant ones. Two models were built using a support vector machine classifier, one was to classify benign and malignant lymph nodes and the other further distinguished four different diseases. The performance was assessed by receiver operating characteristic curves and decision curve analysis.ResultsBy LASSO, 20 features were selected to construct a model to distinguish benign and malignant lymph nodes, which achieved an area under the curve (AUC) of 0.89 and 0.80 in the training and testing sets, respectively. Sixteen features were selected to construct a model to distinguish four different cervical lymphadenopathies. For each etiology, Kikuchi disease, reactive hyperplasia, suppurative lymphadenitis, and malignancy, an AUC of 0.97, 0.91, 0.88, and 0.87 was achieved in the training set, and an AUC of 0.96, 0.80, 0.82, and 0.82 was achieved in the testing set, respectively.ConclusionMRI-derived radiomic analysis provides a promising non-invasive approach for distinguishing causes of cervical lymphadenopathy in children.Graphical

Infection dynamics following experimental challenge of pigs orally dosed with different stages of two archetypal genotypes of Toxoplasma gondii

Toxoplasma gondii is a food-borne zoonotic parasite widespread in a variety of hosts, including humans. With a majority of infections in Europe estimated to be meat-borne, pork, as one of the most consumed meats worldwide, represents a potential risk for consumers. Therefore, we aimed to investigate the progress of T. gondii infection and tissue tropism in experimentally infected pigs, using different T. gondii isolates and infectious stages, i.e. tissue cysts or oocysts. Twenty-four pigs were allocated to treatment in four groups of six, with each group inoculated orally with an estimated low dose of either 400 oocysts or 10 tissue cysts of two European T. gondii isolates, a type II and a type III isolate. The majority of pigs seroconverted two weeks post-inoculation. Pigs infected with the type III isolate had significantly higher levels of anti-T. gondii antibodies compared to those infected with the type II isolate. Histopathological exams revealed reactive hyperplasia of the lymphatic tissue of all pigs. Additionally, a selected set of nine tissues was collected during necropsy at 50 dpi from each of the remaining 22 pigs for T. gondii DNA detection by quantitative real-time PCR. A positive result was obtained in 29.8 % (59/139) of tested tissues. The brain was identified as the most frequently positive tissue in 63.6 % (14/22) of the animals. In contrast, liver samples tested negative in all animals. The highest mean parasite load, calculated by interpolating the average Cq values on the standard curve made of ten-fold serial dilutions of the genomic DNA, corresponding to 100 to 104 tachyzoites/µL, was observed in shoulder musculature with an estimated concentration of 84.4 [0.0–442.5] parasites per gram of tissue. The study highlights the variability in clinical signs and tissue distribution of T. gondii in pigs based on the combination of parasite stages and strains, with type III isolates, particularly oocysts, causing a stronger antibody response and higher tissue parasite burden. These findings suggest the need for further investigation of type III isolates to better understand their potential risks to humans.

P16 Expression in Multinucleated Stromal Cells of Fibroepithelial Polyps of the Anus (FEPA): A Comprehensive Review and Our Experience

Fibroepithelial polyps of the anus (FEPA) are a common benign polypoid proliferation of the stroma covered by squamous epithelium. They are also an often-overlooked part of pathological practice. Currently, immunohistochemistry (IHC) for p16 is the only recommended test for anal intraepithelial neoplasia, but the expression of p16 in stromal multinucleated atypical cells in FEPA has not been described. We aimed to evaluate the expression of p16 in stromal multinucleated atypical cells in FEPA and its role as a diagnostic biomarker to determine the origin of the atypical multinucleated cells in the stroma of FEPA and to rule out the possibility of a neoplastic process. Therefore, we researched a series of 15 FEPA in middle-aged patients histologically and by IHC. Examination of the subepithelial connective tissue from the FEPA showed bizarre, multinucleated cells, while their causal relationship with human papillomavirus (HPV) infection was rejected. In all cases, these cells showed mild to moderate atypical nuclear features and positive expression for p16, while the overlying squamous epithelium was negative. We concluded that FEPA are benign lesions in the stroma where mononuclear and multinucleated (sometimes atypical) cells showing fibroblastic and myofibroblastic differentiation can be found. Nevertheless, we believe that these cells have a practical diagnostic significance, although sometimes the presence of giant cells is difficult to establish, especially in the inflammatory context. The histological similarity between FEPA and normal anal mucosa supports the hypothesis that FEPA may represent the reactive hyperplasia of subepithelial fibrous connective tissue of the anal mucosa.

Lymphocytoma Cutis - A Case Report

Without tissue biopsy and holistic review of presentation, histology, and immunohistochemistry, lymphocytoma cutis (LC) can often be misdiagnosed as other benign conditions or malignant pathologies such as cutaneous B cell lymphoma (CBCL). A 36-year-old female presented with a two-year history of a progressive indurated, edematous plaque in the preauricular area. At presentation, the patient also had labs significant for thrombocytopenia and eosinophilia. Original treatment with topical steroids did not lead to clinical improvement of the lesions. Punch biopsy revealed reactive lymphoid hyperplasia with polyclonal lymphoid infiltrates of small lymphocytes, histiocytes, eosinophils, and plasma cells. Diagnosis of LC was made and our patient was treated with serial 5 mg intralesional triamcinolone injections. Clinical improvement was seen beginning at 2 months. Diagnosing LC can be particularly difficult as the clinical presentation is ubiquitous and can resemble several other conditions such as CBCL, cutaneous lupus erythematosus, sarcoid, or hypersensitivity reactions. Recognition of the typical histologic findings of top-heavy dermal mixed-cellular infiltrates along with polyclonal kappa and lambda hybridization on immunohistochemistry is often essential in arriving at the correct diagnosis. Following diagnosis of LC, long-term surveillance is recommended as malignant transformation is a possibility.

The Utilisation of Fine Needle Aspiration Cytology for Diagnosis of Head and Neck Lesions in Paediatric Age Group

The Utilisation of Fine Needle Aspiration Cytology for Diagnosis of Head and Neck Lesions in Paediatric Age Group