Reactive Lymphoid Hyperplasia Research Articles

Comparison of Appendicitis Scoring Systems in Pediatric Patients

BACKGROUND: Acute appendicitis is one of the most common causes of emergency department (ED) admission among pediatric patients, and the most common cause of abdominal pain requiring surgical intervention. The present study aimed to measure the success of three different appendicitis scoring systems in patients who were operated due to acute appendicitis (AA) upon presenting at the pediatric ED with acute abdominal pain. METHODS: The study included a total of 226 patients who were admitted to Pediatric Emergency Department and who underwent an appendectomy between December 2018 and May 2019. Through a retrospective review of patient files; age, gender, clinical findings, laboratory results, Pediatric Appendicitis Score (PAS), Lintula score, Acute Inflammatory Response (AIR) score, ultrasonography (USG) findings and pathology results of the patients operated due to AA were recorded. RESULTS: A total of 226 patients were included in the study, with a mean age of 11.6±3.66 (1-17) years, and 57.1% (n=129) of the patients were female and 42.9% (n=97) were male. The pathology results were evaluated under three categories: suppurative (phlegmonous) appendicitis, 74.3%; perforated appendix, 9.7%; and reactive lymphoid hyperplasia, 15.9%. The cut-off values >3 for AIR, >7 for PAS and >15 for Lintula were found statistically significant. Among the three scoring systems, Lintula had the highest sensitivity (91.5%) and PAS had the highest specificity (69.4%). DISCUSSION:Although scoring systems are used to diagnose AA, the selected cut-off values for the scoring systems have an effect on the results.. Patients with a PAS score of ≥7 were found to have more significant AA results. We believe that PAS is likely to be a preferred scoring system in pediatric patients, especially under busy ED conditions; however, further studies with larger populations are needed to develop scoring systems that will guide physicians to establish a final diagnosis.

Non-neoplastic Lesions among Lateral Neck Mass Specimens in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Lateral neck masses present clinically as neoplastic or non-neoplastic lesions of lymph nodes, salivary glands, and thyroid. Non-neoplastic lesions, if evaluated timely, may not transform into malignancy thus reducing clinical burden. A cytomorphological study using fine needle aspiration is a reliable method for the diagnosis of such masses. The aim of this study was to find out the prevalence of non-neoplastic lesions of lateral neck mass specimens received in the Department of Pathology in a tertiary care center. This descriptive cross-sectional study was carried out in the Department of Pathology among lateral neck mass specimens of a tertiary care center from January 2019 to December 2020 after obtaining ethical approval from the Institutional Review Committee (Reference no: 155/19). A convenience sampling method was used and data analysis was done in Microsoft Excel 2019. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 300 lateral neck mass specimens, non-neoplastic lesions were found in 246 (82%) (77.7-86.3 at 95% Confidence Interval). The involvement of lymph nodes in 117 (47.6%) was the most common finding followed by thyroid 112 (45.5%). Among non-neoplastic lesions, the cytomorphological features of benign nodular goiter 93 (37.8%) was the most common lesion followed by reactive lymphoid hyperplasia 73 (29.7%). The study showed that the prevalence of non-neoplastic lesions was similar to that of other national and international studies.

English

BACKGROUND Lymphadenopathy is a common clinical condition and biopsies are usually undertaken to determine the cause of nodal enlargement, which may be neoplastic or non-neoplastic. The neoplastic disorders are categorized into haematolymphoid malignancies and metastasis, while the causes of non-neoplastic lymphadenopathy are diverse. This study was undertaken to determine the histopathological spectrum in lymph node biopsies. METHODS This was a descriptive study of 357 cases of histologically diagnosed peripheral lymph node biopsies in the Department of Pathology, Govt. Medical College, Thiruvananthapuram, Kerala, S. India conducted from January 2019 to December 2019. Treated cases of malignancies were excluded. RESULTS The non-neoplastic lesions were more common accounting for 67.2 % (240 cases) which included 40.3 % (144 cases) of non-specific reactive lymphoid hyperplasia, 3.9 % (14 cases) of other specific lymphoid hyperplasia, 16.2 % (58 cases) of tuberculous lymphadenitis, 6.7 % (24 cases) of other granulomatous lesions. Neoplastic lesions accounted for 32.8 % (117 cases) and included 16.2 % (58 cases) of non-Hodgkin’s lymphoma, 3.9 % (14 cases) of Hodgkin’s lymphoma and 12.6 % (45 cases) of metastatic lesions. CONCLUSIONS Lymph node biopsy plays an important role in establishing the cause of lymphadenopathy. Among the biopsied nodes, reactive follicular hyperplasia was the most common (40.3 %) followed by Non-Hodgkin’s lymphoma and tuberculous lymphadenitis (16.2 % each) and metastasis (12.6 %). KEYWORDS Lymphadenopathy, Lymph Node, Metastasis, Non-Hodgkin’s Lymphoma, Reactive Lymphoid Hyperplasia, Tuberculosis

Identification of miRNA-34a and miRNA-155 as prognostic markers for mantle cell lymphoma.

ObjectiveMicroRNAs (miRNAs) with functional relevance have not been previously identified in mantle cell lymphoma (MCL). Here, we aimed to evaluate the relationships between miR-34a and miR-155-5p and MCL clinicopathology and prognosis.MethodsSeventy-five paraffin-embedded tissue samples from patients with MCL who completed at least four cycles of chemotherapy from January 2006 to October 2016, and 27 samples from control patients with reactive lymphoid hyperplasia (RLH), were collected. MiRNA expression levels were measured by qRT-PCR.ResultsThe miR-155-5p levels were significantly higher in patients with MCL than in the controls. The Eastern Cooperative Oncology Group (ECOG) ≥ 2 and Sex-Determining Region Y-Box transcription factor 11 (SOX11) < median value (M) groups presented lower miR-34a expression than the ECOG < 2 and SOX11 ≥ M groups, respectively. MiR-155-5p expression differed between low, intermediate, and high MCL International Prognostic Index risk groups. The AUCs of miR-34a and miR-155-5p were 0.5819 and 0.7784, respectively. The median survival times of the miR-34a ≤ 0.2150 and miR-155-5p > 2.11 groups were shorter than those of the miR-34a > 0.2150 and miR-155-5p ≤ 2.11 groups, respectively.ConclusionsLow miR-34a and elevated miR-155-5p levels may be correlated with poor prognosis in MCL.

Cytomorphological Study of Lymph Nodes Lesions among Sudanese Patients

Background: This is a hospital based descriptive study conduct at Al Mubarak Cytopathology lab (Khartoum State) during the period from November to December 2020. Aim: The study aimed to identify the common cytopathological patterns of lymphadenopathy among Sudanese patients. Materials and Methods: Fifty patients presenting with peripheral lymphadenopathy were included in the study, their ages ranging from 4 to 84years, with a mean age of 39.22 years old. Demographic characteristics, clinical manifestations and FNA materials were prospectively obtained. Results: FNA was performed in 92 cases (100%). There were no technical complications. All cases confirmed adequacy of specimen. Overall, FNA demonstrated 34 (37%) benign lesions and 58 (63%) malignant diagnosis. The benign lesions were reactive lymphoid hyperplasia 25 (31.5%) followed by Tuberculous lymphadenitis 5 (5.4%). Malignant cases were diagnosed with Metastatic carcinoma 43 (42.4%), Non- Hodgkin’s lymphoma 10 (1.8%) and Hodgkin`s lymphoma 5 (9.9%). Conclusion: Metastatic carcinoma and reactive hyperplasia were the most common causes of lymph node lesions among lymphadenopathy Sudanese patients.

Effect of Total Macroscopical Sampling of the Pediatric Appendectomy Specimen on Histopathological Diagnosis

Introduction: Acute appendicitis is considered the most common abdominal surgery in children. Pathological examination of the appendectomy specimen mainly is performed to document the presence or absence of inflammation and confirm the clinical diagnosis. If the diagnosis made by the pathologist is as ‘no appendicitis’, then clinical work up for other causes should be performed. Routine macroscopic evaluation of the appendectomy specimen consists of obtaining one section each from the base, body and the tip of the appendix and additional sections obtained from exuding or perforated areas. The aim of this study is to evaluate if the final pathological diagnosis would change when the appendectomy specimen is sampled totally. Materials and Methods: In the present study, we performed conventional macroscopical sampling from the tip, body and base of the appendix and embedded these tissues in the first two cassettes, then the rest of appendix was completely sampled in additional two to five casettes. The histopathological diagnosis of conventionally sampled tissues and the histopathological diagnosis of total macroscopical sampling were analyzed and compared. Results: A total of 87 appendectomies were evaluated, of which 58.6 % were male, and the mean age was 11.7 (1 years-18 years). The initial histopathological diagnosis was changed in 14 (16%) cases. In 8 (9.2%) cases, the initial diagnosis of reactive lymphoid hyperplasia changed to acute focal appendicitis (early appendicitis). In 4 (4.6%) cases the initial diagnosis of acute suppurative appendicitis changed to acute suppurative and perforated appendicitis, and in 2 (2.2%) cases acute perforated appendicitis changed to acute perforated and gangrenous appendicitis. Conclusion: Total macroscopical sampling of the appendectomy specimen in cases of negative appendicitis would improve the diagnosis and can document early appendicitis in pediatric cases.

Follicular tissue fragments in fine-needle aspiration cytology of lymph nodes: A useful clue in differential diagnosis of follicular lymphoma and reactive follicular hyperplasia.

In Fine-needle aspiration cytology (FNAC) of lymph nodes, tissue fragments derived from follicular structures may be observed in specimens. We defined such tissue fragments as follicular tissue fragments (FTF), and investigated differences in cytological findings for FTFs of each histological type. A total of 41 cases with FNAC of lymph nodes were examined. In these cases, the histopathological diagnoses were reactive lymphoid hyperplasia (RLH) (n=17), follicular lymphoma (FL) (n=13), diffuse large B-cell lymphoma (DLBCL) (n=18), and Burkitt lymphoma (n=1). Specimens were analyzed for the presence of FTFs, and for tingible-body macrophages (TBMs) and monomorphism of lymphocytes in FTFs. FTFs with a maximum diameter of >500 μm were defined as large-FTFs. FTFs were identified in RLH (14/17, 82.4%), FL (13/13, 100%), and DLBCL (3/18, 16.7%). In the RLH subtypes, FTFs were present only in follicular hyperplasia (FH) (14/15, 93.3%) and not in paracortical hyperplasia (0/2). The number of cases with large FTFs among those with FTFs were as follows: RLH (10/14, 71.4%), FL (11/13, 84.6%), and DLBCL (0/3). Similarly, those with TBMs in FTFs were as follows: RLH (13/14, 92.9%), FL (0/13) and DLBCL (2/3, 66.7%). Monomorphism was observed in RLH (1/14, 7.1%) and FL (11/13, 84.6%), but not in DLBCL (0/3). Distinction between FL and FH is possible by identifying large-FTFs. In FL, TBMs are absent in FTFs and lymphocytes often show monomorphism. Therefore, recognizing FTFs and observing details inside the FTFs are useful for identification and differential diagnosis of FL and FH in FNAC of lymph nodes.

Clinicopathological characteristics of lymphoproliferative disorders in 232 patients with rheumatoid arthritis in Japan: A retrospective, multicenter, descriptive study.

To describe the clinicopathological characteristics of lymphoproliferative disorders (LPDs) in patients with rheumatoid arthritis (RA). In this multicenter case series, we retrospectively reviewed the medical records of RA patients who were newly diagnosed as having LPDs with or without biopsy confirmation between 2000 and 2017 in eight hospitals in Japan. We included 232 patients with LPDs. The median age was 67 years (interquartile range [IQR], 60-73 years), and 77.1% were female. At the time of LPD diagnosis, 94.8% and 62.6% of the patients were methotrexate users and in remission or had low RA disease activity, respectively; lymphadenopathy and extranodal involvement were present in 77.1% and 51.9%, respectively. Major extranodal sites were the lungs and oral/oropharyngeal mucosa. The most common LPD pathological subtype was diffuse large B-cell lymphoma (40.5%), followed by classic Hodgkin lymphoma (10.8%), Epstein-Barr virus-positive mucocutaneous ulcer (7.7%), and reactive lymphoid hyperplasia (6.2%). The clinical and laboratory characteristics varied across the pathological subtypes. LPD occurred mainly in methotrexate users, while RA disease activity did not seem to be associated with LPD development. Although the clinical manifestations vary among pathological subtypes, manifestations of LPD in patients with RA can include lymphadenopathy, extranodal mass, and mucocutaneous ulcer.

Diagnostic value of lymph node fine-needle aspiration cytology.

Objectives:This study aims to assess the diagnostic accuracy of cytology by comparing the results of fine-needle aspiration cytology (FNAC) and histopathologic examination.Material and Methods:A 4-year retrospective study design was conducted on FNAC samples from the lymph nodes of patients in our hospital between January 2015 and December 2018. The cytopathological diagnoses were compared with the histopathological results of the same excised lymph nodes. Diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate were calculated.Results:A total of 392 lymph nodes were aspirated during the study period. Cytologic analysis of the lymph nodes revealed the following: Reactive lymphoid hyperplasia, 239 (61%); metastatic, 61 (15.6%); granulomatous lymphadenitis, 24 (6.1%); suspicious, 24 (6.1%); pyogenic abscess, 10 (2.6%); necrosis, 4 (1%); non-Hodgkin lymphoma, 2 (0.5%); and non-diagnostic, 28 (7.1%). Immunohistochemical analysis was performed on 26 (6.6%) cases to the cell block samples. Histopathological correlation was available in 73 (18.7%) cases. The overall diagnostic sensitivity, specificity, PPV, and NPV of FNAC of lymph nodes were 87.9%, 100%, 100%, and 89.7%, respectively. The overall diagnostic accuracy was 94.1%. In case of malignancies, the histopathological correlation was 100%. Of four cases with false negative, three were low-grade non-Hodgkin lymphoma and one was granulocytic sarcoma.Conclusion:FNAC of lymph nodes is a safe, easy, cheap, quick diagnostic tool and reduces the need for diagnostic excisional biopsy in many patients. Cytological diagnosis can be supported with immunohistochemical analysis of cell block samples. However, lymphomas, particularly low-grade non-Hodgkin lymphomas, are a diagnostic challenge and additional studies such as flow cytometry are required in cases with suspicious for lymphoma.

Clinico-Histological presentation of Head and Neck Lesions in a Tertiary Care Hospital

Objective: This study aimed to see the clinical presentation and histological pattern of various head and neck lesions.Materials and Methods: This descriptive study was conducted in the Department of Pathology, Bannu Medical College in association with the Department of Surgery and ENT, Khalifa Gul Nawaz Teaching Hospital, Bannu. A total of 184 cases of head and neck lesions biopsy were subjected to histopathological diagnosis. Patients' age, gender, anatomical location, and other relevant necessary clinical findings were recorded on an already designed proforma. All biopsies were received in 10% buffered formalin, fixed overnight, and processed for histopathological examination and diagnosis. Inclusion criteria were patients with head and neck lesions including skin, salivary gland, lymph node, and oral cavity of any age and gender. Exclusion criteria were thyroid, nasal cavity lesions, autolysed, and insufficient biopsy specimen. Results: In this study, the mean age was 28.58 ± 17.34 years, and the age range was from 10 to 80 years. The male-to-female ratio was 1.3:1. The most common age group was 36-45 years followed by 46-55 years and 26-35 years etc. The most common inflammatory lesion was granulomatous lymphadenitis 14.67% followed by reactive lymphoid hyperplasia 9.23%. Common benign lesions were pleomorphic adenoma 5.97% followed by lipoma and hemangioma 3.80% and 3.26% respectively. Amongst malignant lesions basal cell carcinoma 23.91% of the face was the commonest lesion followed by squamous cell carcinoma 22.28% of the oral cavity. Conclusion: This study show spectrum of lesions from inflammatory to benign and malignant, occurring in the head and neck region. Malignant lesions are more common as compared to benign and inflammatory lesions, basal cell carcinoma of the skin is the commonest malignant lesion followed by squamous cell carcinoma of the skin and oral cavity.

Valproate-induced reactive lymphoid hyperplasia in pediatric population: A rare case report

Certain drugs may give rise to lymph node enlargement, predominantly in the neck known as drug-induced lymphadenopathy which may be associated with the involvement of DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) of drug reaction with eosinophilia and systemic symptoms also known as drug-induced hypersensitivity syndrome. It can also resemble lymphoma morphologically and this condition is known as pseudolymphoma. Valproate, a broad-spectrum antiepileptic, also used in bipolar disorders and migraine prophylaxis, is generally well tolerated. To date, very few cases of valproate monotherapy-induced lymphoid hyperplasia have been reported worldwide. Here, we are reporting one such rare case in a 13-year-old Indian male child who developed cervical lymphoid hyperplasia following the use of sodium valproate for 5 months for a seizure disorder.

Characteristics of rheumatoid arthritis with immunodeficiency-associated lymphoproliferative disorders to regress spontaneously by the withdrawal of methotrexate and their clinical course: A retrospective, multicenter, case-control study.

To investigate clinical characteristics and time course of lymphoproliferative disorders (LPDs) in rheumatoid arthritis (RA) patients after methotrexate (MTX) discontinuation, in those who achieved spontaneous regression (SR). We retrospectively reviewed clinical data from RA patients with LPDs obtained from eight institutions between 2000 and 2017 and compared clinical and pathological findings between SR and non-SR groups. Among 232 RA patients with LPDs, 216 were treated with MTX at the onset of LPD and 144 (66.7%) achieved SR after MTX discontinuation. Higher MTX doses, high titers of anti-CCP antibodies (>13.5 U/mL), and lower LDH and soluble IL-2 receptor levels were associated with SR. Lymphocyte count was decreased at LPD onset and increased at 2 weeks after MTX discontinuation in the SR group. Epstein-Barr virus-positive mucocutaneous ulcer, reactive lymphoid hyperplasia and unclassifiable B-cell lymphoma, were more frequent in the SR than in the non-SR group. In multivariable analysis, diffuse large B-cell lymphomas was an independent predictive factor for non-SR. In the patients with SR, 73.9% achieved partial or complete regression as early as 2 weeks after MTX discontinuation. SR and non-SR in RA patients with LPDs after MTX discontinuation were associated with certain clinical characteristics.

Upregulation of fatty acid synthase in MYC and BCL-2 double-expressor lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is the most common and heterogeneous lymphoid malignancy. The subtype with MYC and BCL-2 double-expressor lymphoma (DEL) was defined by its aggressive nature and poor survival outcome. Therefore, the development of effective therapies for the DEL subtype is imperative. Fatty acid synthase (FASN) activity is associated with altered lipid metabolism and aberrant protein translation in DLBCL. However, the inter-regulation of these key processes is not fully determined in DEL. In the present study, the clinical and biological impact of FASN was investigated in the DEL subtype. Initially, FASN expression levels were analyzed from a patient cohort and the data indicated that the highest FASN expression was noted in DEL tissues compared with that noted in the DLBCL and reactive lymphoid hyperplasia tissues. Patients with DEL with combined high-FASN expression indicated poorer EFS outcomes than the rest of the patients. In vitro data indicated that FASN was overexpressed in SU-DHL-2 and U2932 cells. Silencing FASN decreased cell growth and promoted cell apoptosis by modulating the pERK/BCL-2 signaling pathway. In conclusion, the present study indicated that FASN was overexpressed in DEL and that its expression was associated with poor survival outcomes. Furthermore, the data demonstrated that FASN regulated the biological function via the pERK/BCL-2 signaling pathway. FASN serves a critical role in the progression of DEL and its expression may be associated with the development to a more aggressive phenotype of DLBCL. Therefore, it may be considered a potential therapeutic target for DLBCL.

Expression of FOXP1 and p53 in Reactive Lymphoid Lesion and B-cell Non-Hodgkin Lymphoma, Large Cell Type

Lymphoproliferative lesions that have morphology between benign and malignant are difficult to diagnoseeven with immunohistochemical and clonality testing. The correct diagnosis is necessary for the prompttreatment. These lesions can also serve as instructive models of lymphomagenesis. FOXP1 plays an importantrole in B-cell development, has a potential oncogene in B-cell Non-Hodgkin lymphoma, and p53 proteinhas a crucial role in the regulation of cell cycle, DNA repair, apoptosis, and senescence tumor suppressionactivity. In this study, we analyze the role of FOXP1 and p53 expression in reactive lymphoid hyperplasiaand B-cell Non-Hodgkin lymphoma, large cell type. 68 paraffin blocks samples from patients diagnosedas reactive lymphoid hyperplasia and B-cell Non-Hodgkin lymphoma, large cell type was sectioned andstained with immunohistochemistry for FOXP1 and p53, and the percentage of nuclear cells showingpositive staining were evaluated. Expression of FOXP1 and p53 in B-cell Non-Hodgkin lymphoma, largecell type is higher than in reactive lymphoid hyperplasia with p=0.001 and cutoff point 45%(CI=95%) forFOXP1 and p=0.001 and cutoff point 7.5%(CI=95%) for p53. There is a significant correlation between theexpression of FOXP1 and p53 in reactive lymphoid hyperplasia and B-cell Non-Hodgkin lymphoma, largecell type (p=0.001). Our findings suggest that high expression of FOXP1 and p53 in B-cell Non-Hodgkinlymphoma may demonstrate the role of FOXP1 and p53 in lymphomagenesis and these markers may helpto distinguish benign and malignant lymphoproliferative lesions.

Hepatic Pseudolymphoma: Case Report and Review

Purpose: Hepatic Pseudolymphoma or Reactive Lymphoid Hyperplasia is a rare benign neoplasia characterized by a polyclonal lymphocytes proliferation gathered in nodes with an active germinal center. It`s pathophysiology is uncertain though it is clearly related to inflammatory or infectious diseases, collagen disorders and malignancy. Diagnosis is often difficult due to its similarities to malignant tumors. If diagnostic is confirmed, a conservative approach may be applied. Method: A 57 years old woman with a history of lung adenocarcinoma T1a surgically managed by a left inferior lobectomy in 2015. That same year the patient develops an idiopathic autoimmune hemolytic anemia treated with steroids. During follow-up dissociated cholestasis is detected with elevation of hepatic enzymes. Primary Biliary Cholangitis was suspected. Imaging studies (RMI, US) show an 18mm hypervascular nodule between liver segments II and III. Core Needle Biopsy is performed showing polymorphic lymphoid infiltrations, polyclonal lymphocytes B and T, and germinal center cells, findings compatible with hepatic pseudolymphoma or low grade lymphoma. Results: Segment III hepatectomy was performed, without postoperative complications. Patient was discharged 2 days after surgery. Studies confirm hepatic pseudolymphoma. After 54 months follow up no recurrence has been detected. Conclusion: Hepatic Pseudolymphoma is a rare (less than 70 published cases) benign disease, often associated to autoimmune disorders, malignancy or collagen disorders. Treatment of this pathology could be conservative, but the difficulties regarding differential diagnosis (malignancy) makes surgical approach often required. If diagnostic is confirmed, a conservative approach may be applied.

The effectiveness of the Raja Isteri Pengiran Anak Saleha Appendicitis Score in the diagnosis of acute appendicitis in elderly patients

Acute appendicitis (AA) is the most common cause of acute abdominal surgeries, accounting for 15% of all emergency visits due to acute abdominal pain in patients aged over 60 years. Appendicitis is reported as the third most common cause of abdominal surgery in geriatric patients. In this current retrospective study, the records of 68 patients aged over 65 years, who were treated by surgical resection in our clinic diagnosed for AA between February 2015 and February 2020, were analyzed. The age, gender, duration of hospital stay of the patients and, histopathological results of appendectomy specimens were recorded. The Raja Isteri Pengrian Anak Saleha Appendicitis (RIPASA) Score of the patients was calculated according to the clinical history, physical examination, and laboratory parameters of the patients. According to the RIPASA scores, the patients were divided into three groups as the low-score group (4 to 7), the intermediate-score group (7.5 to 11.5), and the high-score group (≥ 12). The groups were compared on the basis of the microscopic diagnosis. According to the calculated RIPASA score, there were 12 patients in the low-score group, 44 patients in the intermediate-score group, and 12 patients in the high-score group. When the results were classified based on the pathology, we detected non-complicated conditions such as a normal appendix or reactive lymphoid hyperplasia in ten patients and catarrhal stage appendicitis in 38 patients along with complicated (gangrenous or perforated) appendicitis in 20 patients. In conclusion, the RIPASA score can be used in elderly patients considering its high accuracy rate. In elderly patients with a high RIPASA score, the pathological stage of the appendectomy specimen may also be complicated (perforated or gangrenous) appendicitis. Therefore, the mortality and morbidity rates may increase with increased complication rates.

Hepatic Reactive Lymphoid Hyperplasia and Primary Hepatic Lymphoma: Ultrasound Features and Differentiation Diagnosis

Hepatic Reactive Lymphoid Hyperplasia and Primary Hepatic Lymphoma: Ultrasound Features and Differentiation Diagnosis

The histomorphological pattern of various tonsillar lesions. A 3-year study in the tertiary care center.

Introduction: Palatine tonsils are paired masses of lymphoid tissue, which act as an immunologicbarrier against the entry of pathogenic agents into the respiratory and digestive tracts. Tonsillitis is acommon disease, especially among children. Chronic tonsillitis is a disease with repeated attacks ofacute tonsillitis or a sub-clinic form of a resistant or poorly treated infection. Aim: To determine theclinicopathological findings in various lesions of tonsillectomy in the palatine tonsil. Materials andmethods: This is a retrospective study where 105 (Unilateral-20, Bilateral) cases ofhistopathologically identified tonsillectomy specimens as well as 4 tonsillar biopsies were included.The available data for all the patients as regards age, sex, and clinical symptoms were collected.Sections were taken from tonsillectomy specimens from representative areas while tonsillar biopsieswere processed completely. Routine hematoxylin and eosin staining was done along with this specialstain- PAS (periodic acid- Schiff) for actinomycosis and ZN stain for AFB. Results: Amongst thecases, 78 cases showed chronic tonsillitis. 11 cases were chronic tonsillitis with actinomycosis, acutechronic tonsillitis in 07 cases, granulomatous tonsillitis in 03 cases, acute ulcerative tonsillitis withmicroabscesses in 01 case, and reactive lymphoid hyperplasia in 02 cases. Three malignancies wereobserved – Two cases of squamous cell carcinoma and one case of undifferentiatedcarcinoma/lymphoma. Conclusion: Chronic tonsillitis is a common problem facing in all age groups,Histopathology plays a significant role in diagnosing both benign and malignant lesions of the tonsil.

The imaging signs and significances of the enlargement of the infraorbital nerve and the frontal nerve in orbital lymphoproliferative diseases

Objective: To describe imaging signs of infraorbital nerve enlargement (IONE) and frontal nerve enlargement (FNE) in orbital lymphoproliferative diseases (LPDs), and to explore the diagnostic value and differential diagnostic role of the signs. Methods: A retrospective case series study. The data of 222 cases (262 eyes) of LPDs and 95 cases (134 eyes) of inflammatory pseudotumors (IPs) pathologically confirmed by the Peking University People's Hospital and the Third Medical Center of the Chinese PLA General Hospital from January 2013 to December 2018 were analyzed. The LPDs were lymphoma (including atypical lymphoid hyperplasia) in 91 cases (110 eyes) and reactive lymphoid hyperplasia (RLH) in 131 cases (152 eyes). The patients with LPD included 101 males and 121 females, aged (58±17) years, and the patients with IP included 44 males and 51 females, aged (49±21) years. All patients underwent orbital CT or MRI with T1 weighted imaging, T2 weighted imaging and enhanced T1 weighted imaging scanning. Slice thickness was 3 mm. In the coronal CT or MRI, the criterion for determining IONE was the inferior orbital nerve diameter greater than the optic nerve, and the criterion for determining FNE was the forehead nerve diameter equal to or greater than the optic nerve. The pathological types and imaging features of nerve enlargement were recorded. The incidence rates of different pathological types were compared using chi-square test. Results: The enlarged nerves showed homogeneous soft tissue density on CT images, accompanied with enlarged bony infraorbital nerve grooves (foramina). MRI showed moderate signals of T1 and T2 weighted imaging, with clear boundaries and obvious enhancement, which could spread to the pterygopalatine fossa and the cranial cavity. The accompanying images included the enlargement of lacrimal glands or extraocular muscles, intraorbital mass or sinuses opacity. The IONE and/or FNE were found in 12 patients with LPD, but were not found in any patients with IP. The difference was statistically significant (12/222 vs. 0/95, χ²=5.337, P=0.021). Among the cases with nerve enlargement, there were 2 cases of diffuse large B cell lymphoma and 10 cases of RLH (2/91 vs. 10/131, χ²=3.103, P=0.078), as well as 7 cases of IgG4-related ophthalmic disease (IgG4-ROD) and 3 cases of non-IgG4-ROD (7/28 vs. 3/103, χ2=15.232, P=0.000). Conclusions: Lymphoma and RLH can express IONE and/or FNE, in which the IgG4-ROD is the most common and specific type. CT and MRI scans can show enlarged nerves and accompanying signs. Neural thickening can also be applied as a discrimination marker of LPDs and IPs. (Chin J Ophthalmol, 2020, 56: 832-838).

Comprehensive Gene Analysis of IgG4-Related Ophthalmic Disease Using RNA Sequencing.

High-throughput RNA sequencing (RNA-seq) uses massive parallel sequencing technology, allowing the unbiased analysis of genome-wide transcription levels and tumor mutation status. Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is a fibroinflammatory disease characterized by the enlargement of the ocular adnexal tissues. We analyzed RNA expression levels via RNA-seq in the biopsy specimens of three patients diagnosed with IgG4-ROD. Mucosa-associated lymphoid tissue (MALT) lymphoma, reactive lymphoid hyperplasia (RLH), normal lacrimal gland tissue, and adjacent adipose tissue were used as the controls (n = 3 each). RNA-seq was performed using the NextSeq 500 system, and genes with |fold change| ≥ 2 and p < 0.05 relative to the controls were defined as differentially expressed genes (DEGs) in IgG4-ROD. To validate the results of RNA-seq, real-time polymerase chain reaction (PCR) was performed in 30 IgG4-ROD and 30 orbital MALT lymphoma tissue samples. RNA-seq identified 35 up-regulated genes, including matrix metallopeptidase 12 (MMP12) and secreted phosphoprotein 1 (SPP1), in IgG4-ROD tissues when compared to all the controls. Many pathways related to the immune system were included when compared to all the controls. Expressions of MMP12 and SPP1 in IgG4-ROD tissues were confirmed by real-time PCR and immunohistochemistry. In conclusion, we identified novel DEGs, including those associated with extracellular matrix degradation, fibrosis, and inflammation, in IgG4-ROD biopsy specimens. These data provide new insights into molecular pathogenetic mechanisms and may contribute to the development of new biomarkers for diagnosis and molecular targeted drugs.