Superficial Mucosa Research Articles

INFLUENCE OF PIGEON PARAMYXOVIRUS TYPE-1 ON CLINCOPATHOLOGICAL PROFILES IN RACING PIGEONS ASSOCIATED WITH RECENT OUTBREAKS IN IRAQ

The number of racing pigeons recently increased in Iraq accompanied by significant increases in the number of events similar to the neurotrophic velogenic group of ND viruses in different regions. Thus, this research was designed to study the influence of natural infection with PPMV-1 on clincopathological profiles in four PPMV-1-associated mortality events in racing pigeons in the southern part of Iraq. The result revealed that HI antibody titers above the positivity threshold of four events were seen in (9 out of 24) of tested pigeons in all events, and the predominant signs included polyuria followed by neural symptoms which appear in most of the affected pigeons in the flock. All events showed a high mortality rate (60% - 70%) and absence of gross abnormalities in necropsied pigeons. kidney showed widespread interstitial hemorrhage and intensive epithelial sloughing of renal tubular epithelium, marked white pulp hyperplasia and marked peri-arteriolar fibrosis with onion skin appearance in the spleen, and marked destruction of the superficial intestinal mucosa and intensive inflammation in the site of tissue destruction. This study demonstrates the role of PPMV-1 on clincopathological profiles in racing pigeons associated with recent outbreaks in Iraq, polyuria followed by neural symptoms represent the predominant symptoms in the affected pigeons.

Degrees of Inflammation in the Treatment of Subglottic Stenosis in a Rabbit Model: Histopathological Assessment of a Novel Bioabsorbable Ultra-high Ductility Magnesium Alloy Stent

ObjectiveUtilizing a novel histopathological scoring system and subglottic stenosis (SGS) rabbit model, we aimed to compare degrees of inflammation and severity of narrowing in the subglottis between two minimally invasive therapeutic modalities: endoscopic balloon dilation (EBD) alone versus EBD with placement of a bioabsorbable ultra-high ductility magnesium (UHD-Mg) alloy stent. MethodsSGS was induced endoscopically via microsuspension laryngoscopy in 23 New Zealand white rabbits. The control group (n = 11) underwent EBD alone, the study arm (n = 12) underwent EBD with implantation of bioabsorbable UHD-Mg alloy stents. Rabbits were euthanized at 2-, 3-, and 6-weeks after SGS induction, coinciding with wound healing stages. Using Optical Coherence Tomography (OCT), cross-sectional areas of airways were compared to calculate the mean percentage of intraluminal area at sequential time points. A novel histopathological scoring system was used to analyze frozen sections of laryngotracheal complexes. The degree of inflammation was quantified by scoring changes in inflammatory cell infiltration, epithelial ulceration/metaplasia, subepithelial edema/fibrosis, and capillary number/dilation. Univariate analysis was utilized to analyze these markers. ResultsWe found rabbits implanted with the bioabsorbable UHD-Mg alloy stent had statistically significantly higher scores in categories of hyperplastic change (stents vs controls: 1.48 vs 0.46 p < 0.001), squamous metaplasia (22 vs 5 p < 0.001), and neutrophils/fibrin in lumen (31 vs 8, p < 0.001). Rabbits who received EBD alone had higher scores of subepithelial edema and fibrosis (2.70 vs 3.49, p < 0.0256). The stented rabbits demonstrated significantly increased mean percent stenosis by intraluminal mean area compared to controls at 2 weeks (88.56 vs 58.98, p = 0.032), however at all other time points there was no significant difference between intraluminal subglottic stenosis by mean percent stenosis area. DiscussionRabbits with SGS treated with UHD-Mg alloy stents demonstrated histopathologic findings suggestive of lower levels of tracheal fibrosis. This could indicate a reduced tendency towards the development of stenosis when compared to EBD alone. There was not a difference in luminal size between stent and non-stented rabbits at the six-week end point. Histologically, however, overall the use of bioabsorbable UHD-Mg alloy stenting elicited a greater tissue response at the level of the superficial mucosa rather than fibrosis of the lamina propria seen in the stented rabbits. This suggests more favorable healing and less of a tendency towards fibrosis and stenosis even though there may not be a benefit from a luminal size standpoint during this early healing period. Compared to known complications of currently available non-bioabsorbable metal or silicone-based stents, this proof-of-concept investigation highlights the potential use of a novel biodegradable UHD-Mg stent as a therapeutic modality for pediatric SGS.

Current Perspectives on Paradental Cyst: A Literature Review.

Paradental cyst (PC) is an uncommon type of odontogenic cyst of inflammatory origin, which develops near the cervical margin of the outside of the root of a vital tooth. The category of paradental cyst includes the buccal bifurcation cyst, which is found in the buccal area adjacent to the mandibular first or second molars in children. A conclusive diagnosis of a PC needs to correlate the surgical, radiographic, and histologic findings. When strict diagnosis is neglected, they can be easily misdiagnosed and mistreated. PCs associated with mandibular first and second molars and those associated with the mandibular third molar may have slightly different clinical manifestations but have almost completely different treatment principles due to the distinction in location. For the third molars, removal of both the tooth and the cyst is preferred. However, when the first or second molars are affected, it may be advisable to perform enucleation of the lesion while preserving the associated tooth. There are also more conservative methods to retain vital permanent teeth within the mandibular arch. Additionally, the cyst wall primarily consisted of granulation tissue firmly attached to the periodontal ligament space. The exact origin of these cysts was a subject of ongoing debate, but they were believed to primarily arise from either the reduced enamel epithelium or the inflammatory proliferation of junctional/sulcular epithelium, which originate from the superficial mucosa during tooth eruption. The aim of the present review was to update information on clinical manifestations, diagnosis and treatment strategies of cysts and discuss their pathogenic mechanisms. Raising familiarity with the distinctive features is beneficial for accurately diagnosing these lesions and effectively caring for the patients.

Contact Endoscopic Surface Vascular and Epithelial Morphology in Leukoplakia and Carcinoma of the Vocal Cords

Purpose Leukoplakia is a macroscopic morphological term for thick white or grey mucosal patches that can represent various histologic diagnostic entities ranging from hyperplasia to malignancy. Aim was the study morphology of the superficial mucosa and microvascular network of the vocal cords in patients with suspected glottic squamous cell carcinoma (SCC) using contact endoscopy (CE). Material and Methods Seventy-nine patients (21 female, 58 male), with a mean age of 57.5 years ± 7.12 (range, 32–73 years), were prospectively enrolled and evaluated. Of these patients, 58 had leukoplakia (Group A/41 males and 17 females, with a mean age of 53.7 years ± 6.65), and 21 (Group B/ 17males and 4 females/ with a mean age of 60.5 years ± 6.04) had malignant lesions (pT1, n = 6; p T2, n = 8; pT3, n = 8; Group B), as proven by the results of the histological examination. Further, 79 non-smokers (control group—group C) were studied. CE imaging findings were classified into five types (I to V) based on the features of the mucosal intra-epithelial capillary loops. CE findings were correlated to the histologic findings. A separate analysis involving smoking status was done. Results The CE-based intraepithelial papillary capillary loop classification score was strongly correlated with the histological findings. Age was strongly associated with both malignancy and bilateral involvement. Smoking habits didn’t significantly differ between patients with unilateral and bilateral SCC. Conclusions CE imaging of the vocal cord mucosal capillaries may be useful for the early detection of glottic SCC and pre-cancerous lesions.

N-dihydrogalactochitosan reduces mortality in a lethal mouse model of SARS-CoV-2.

The rapid emergence and global dissemination of SARS-CoV-2 that causes COVID-19 continues to cause an unprecedented global health burden resulting in nearly 7 million deaths. While multiple vaccine countermeasures have been approved for emergency use, additional treatments are still needed due to sluggish vaccine rollout, vaccine hesitancy, and inefficient vaccine-mediated protection. Immunoadjuvant compounds delivered intranasally can guide non-specific innate immune responses during the critical early stages of viral replication, reducing morbidity and mortality. N-dihydrogalactochitosan (GC) is a novel mucoadhesive immunostimulatory polymer of β-0-4-linked N-acetylglucosamine that is solubilized by the conjugation of galactose glycans with current applications as a cancer immunotherapeutic. We tested GC as a potential countermeasure for COVID-19. GC was well-tolerated and did not produce histopathologic lesions in the mouse lung. GC administered intranasally before and after SARS-CoV-2 exposure diminished morbidity and mortality in humanized ACE2 receptor expressing mice by up to 75% and reduced infectious virus levels in the upper airway. Fluorescent labeling of GC shows that it is confined to the lumen or superficial mucosa of the nasal cavity, without involvement of adjacent or deeper tissues. Our findings demonstrate a new application for soluble immunoadjuvants such as GC for preventing disease associated with SARS-CoV-2 and may be particularly attractive to persons who are needle-averse.

Clinical application of double V-Y advancement mucosal flap to repair tongue defect.

The repair of small- and medium-sized defects in the oral tongue has always been a challenge, and the effect of free flap and distal pedicle flap is still far from satisfactory. Tongue flap is an ideal choice for repairing small- and medium-sized defects. However, the disadvantages such as poor local morphology restricts the development of this operation.This study aims to investigate the efficacy of double V-Y advancement mucosal flap in repair of small- and medium-sized defects of the tongue defect. The clinical data of 15 patients with tongue defect lesions who were hospitalized in the Department of Stomatology, Third Xiangya Hospital of Central South University from March 2019 to May 2022 were retrospectively analyzed. After the lesions were completely excised, the mucosa and part of the tongue defect were left. One V-Y advancement mucosal flap was designed anteriorly and posteriorly to the defect. The superficial mucosa was incised gradually all around, preserving the deep median muscle tip. The 2 flaps were freed toward the middle of the defect, and the anterior and posterior flaps were sutured together at the middle of the defect, with the donor area directly pulled together and sutured. The double V-Y advancement mucosal flap survived in 15 patients, and the wounds healed at stage I. The postoperative follow-up time was 12-22 months, and the patients had no recurrence, with symmetrical tongue shape, and no traction and deformation in the affected tongue organs. Meanwhile, the intraoral flap was thin and flat, and healed well with the surrounding mucosa, without obvious flap contracture or tongue bite. Double V-Y advancement mucosal flap has the advantages of flexible design, simple preparation, reliable blood supply, and good protection of the donor site, which may be one of the effective methods for repairing small- and medium-sized defects in the anterior tongue mucosa.

Red, infrared, and simultaneous laser-wavelengths irradiation effects on 5-Fluorouracil-induced oral mucositis in hamsters.

The association of more than one wavelength for photobiomodulation therapy (PBMT) to treat oral mucositis (OM) is unusual in the literature. Thus, this study aims to compare the simultaneous irradiation effects with their isolated application to treat OM. In order of that, 48 male Syrian hamsters were divided into 4 groups: Chemotherapy (Ch), which received only a OM induction protocol (5-Fluorouracil chemotherapy and superficial oral mucosa scratches); Red laser (RL), which received the OM induction and a PBMT protocol at 660 nm; Infrared laser (IRL), which received the OM induction, and a PBMT protocol at 808 nm; and the RL+IRL group, which received the simultaneous application, of 660 nm and 808 nm wavelengths. Clinical (OM grade classification), histological (light microscopy analysis with H&E and collagen staining), immunohistochemical (TNF-α expression), and biochemical (TNF-α and hydroxyproline concentration) analyzes were performed after 7 and 10 days. Mainly on the 10th day, the RL and IRL groups showed lower OM grades and faster microscopic repair process, with greater expression of collagen fibers and lower TNF-α levels, besides the higher hydroxyproline concentrations, mainly in comparison with the Ch group. In conclusion, in this study, the simultaneous protocol did not present superior results than the isolated irradiations. This article is protected by copyright. All rights reserved.

Histopathologic Study of Gastritis and Helicobacter Pylori Infection at a Tertiary Centre in Kathmandu

Introduction: Chronic gastritis is a chronic inflammation of the gastric mucosa characterized by infiltration of the superficial mucosa by chronic inflammatory cells and with progressive spread to involve the whole mucosa leading to atrophy and intestinal metaplasia and may even progress to the development of carcinoma. Chronic infection with Helicobacter pylori (H. Pylori) is believed to be the major causative agent in the pathogenesis of chronic active gastritis, duodenal and gastric ulcer along with gastric carcinoma. Sydney system classifies gastritis by the intensity of mononuclear inflammatory infiltrates, activity of polymorphs, atrophy, metaplasia and dysplasia and presence of H. pylori.&#x0D; Methods: Observational, descriptive, cross-sectional retrospective study conducted at Department of Pathology, Kathmandu Model Hospital, Kathmandu, Nepal from January 2015 to December 2015. Record of computerized histopathology reports of all cases of endoscopic gastric biopsies were retrieved from the laboratory. The biopsy samples obtained from both body and antrum were included in the study. The grades of mononuclear cells infiltration, neutrophilic activity, metaplasia, dysplasia and glandular atrophy were determined using the Sydney system classification. The presence or absence of H. pylori was noted in the slides stained with Giemsa stain. Data analysis was done using a Microsoft Excel file.&#x0D; Results: Of 128 samples studied, the most common endoscopic findings were erythematous lesions and mononuclear infiltrate was seen in all cases. 61.7% showed moderate inflammation. The activity was seen in 35.9% of cases. H. pylori organism was noted in 48.4% of cases.&#x0D; Conclusion: The severity of chronic inflammation and neutrophilic activity are significantly associated with infection by this microorganism.

V08-10 ENDOSCOPIC URETHROPLASTY FOR MANAGEMENT OF MALE MEMBRANOUS URETHRAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023V08-10 ENDOSCOPIC URETHROPLASTY FOR MANAGEMENT OF MALE MEMBRANOUS URETHRAL STRICTURE Garrett Ungerer, Jayson Kemble, and Jonathan Warner Garrett UngererGarrett Ungerer More articles by this author , Jayson KembleJayson Kemble More articles by this author , and Jonathan WarnerJonathan Warner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture disease remains a challenging urologic problem, often requiring open repair using grafts or tissue flaps. While endoscopic management offers advantages including minimizing additional surgical trauma to the already scarred urethra and pelvic floor, urethral dilation and/or urethrotomy have been shown to have less durable outcomes compared to other urethroplasty techniques (end-to-end, graft, flap, or two-stage urethroplasty). In this video, we demonstrate a minimally invasive endoscopic approach to urethroplasty using buccal grafting for management of male membranous urethral stricture disease. METHODS: The procedure was performed for management of an 8mm flow limiting stricture within the membranous urethra in a male patient with prior history of prostate cancer managed by radiation who subsequently developed an 8mm flow limiting membranous stricture. The patient is prepped in dorsal lithotomy position. Under direct visualization via cystoscopy, the stricture is first balloon dilated. Next, a posterior strip of the superficial mucosa is resected from the bladder neck to just distal to the area of stricture, creating a 1cm wide bed for the graft to lay. After the defect is measured, a buccal mucosa graft is harvested in standard fashion. Two sutures are placed through the distal corners of the graft with the graft still outside the urethra, and the proximal end of the graft is then secured to the bladder neck using the RD 180 endoscopic suturing device. The proximal suture is cinched tight, pulling the graft to the bladder neck, and the distal end of the graft is pulled tight and flat along the defect using the two sutures attached to the distal graft. The graft is anchored to the posterior urethra using endoscopic Secure Straps. Once the graft is secure, a wire is passed into the bladder under direct visualization and a catheter is passed over wire to hold the graft flat during the subsequent 4 weeks. RESULTS: The procedure lasted 2.5 hours without any complications. Estimated blood loss was 50cc. Following the procedure, the patient was discharged home with a catheter in place. Catheter was removed at 4 weeks. At 10 weeks post-op, cystoscopy showed good graft viability, and peak flow was 20 ml/sec compared to 4 ml/sec pre-operatively. At six months, he continues to do well without evidence of recurrent urethral stricture. CONCLUSIONS: Endoscopic urethroplasty using buccal graft appears to offer a safe and effective repair option that could be considered for management of ureteral strictures. Source of Funding: none to report © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e751 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Garrett Ungerer More articles by this author Jayson Kemble More articles by this author Jonathan Warner More articles by this author Expand All Advertisement PDF downloadLoading ...

A Case of Oral Candidiasis Treated with Fluconazole (Diflucan®) Mouthrinse

Oral candidiasis, a common fungal infection in humans, is characterized by the overgrowth of Candida species in the superficial oral epithelial mucosa. The condition is associated with multiple risk factors, including impaired salivary gland function, oral mucosal damage, and long-term antibiotic or corticosteroid use. Several treatment options are available; nystatin and amphotericin B are the most widely used local medications. Recently, fluconazole has emerged as the preferred systemic treatment. We report a case of oral candidiasis in an 83-year-old male diagnosed with bullous pemphigoid in 2017 and previously administered methylprednisolone. He developed oral candidiasis a few months before presentation and was treated with 10 mL nystatin suspension three times daily; unfortunately, the disease was recalcitrant to this treatment and his symptoms showed no improvement over two months. We discontinued nystatin in favor of fluconazole syrup (Diflucan®) administered by rinsing, then swallowing, 5 mL syrup once daily. The lesion improved after one month of treatment. This case demonstrates the efficacy of fluconazole as a primary treatment for oral candidiasis. The act of rinsing the mouth with syrup exposes the oral mucosa to drug, potentially producing a better treatment response than taking the syrup orally without rinsing.

Safety, tolerability and short-term efficacy of transvaginal fractional bipolar radiofrequency therapy for symptoms of stress and or mixed incontinence in conjunction with genitourinary syndrome of menopause.

Radiofrequency (RF) energy application stimulates collagen and elastin remodeling to restore the elasticity, and moisture of the superficial vaginal mucosa. This is the first study to report on the use of microneedling to deliver RF energy to the vaginal canal. Microneedling increases the response of the collagen contraction and neocollagenesis in deeper layers of tissue, thus increasing the support to the surface. The novel intravaginal microneedling device used in this study allows penetration of the needles to 1, 2, or 3 mm. A prospective study to evaluate the safety and short-term outcome of a single fractional RF treatment of the vaginal canal in a series of women with coexistent stress or mixed incontinence (MUI) and genitourinary syndrome of menopause (GSM). Twenty women who had symptoms of SUI and or MUI in conjunction with GSM were given a single vaginal treatment that consisted of fractional bipolar RF energy using the EmpowerRF platform with the Morpheus8V applicator (InMode). RF energy was delivered into the vaginal walls via 24 microneedles, at a depth of 1, 2, and 3 mm. Outcomes were evaluated by "cough" stress test, questionnaires (MESA SI, MESA UI, iQoL, UDI-6) and evaluation of vaginal tissue through the VHI scale at 1-, 3-, and 6-months post-treatment compared to baseline. Biopsies were performed at baseline and 3-months on five patients for histological reference and tissue evaluation. Eight out of eight outcomes measured from baseline to 6-months post-treatment showed improvement. The parameters scored in the questionnaires including frequency, urgency, nocturia, urge incontinence, and stress incontinence showed significant improvement in all areas at the 1-, 3-, and 6-month follow-up sessions compared to baseline. The results showed evidence that fractional RF energy delivered vaginally is safe, well tolerated, and provide short term improvement of SUI and or MUI in conjunction with GSM.

P008 Fibrostricturing Crohn’s disease is characterised by an imbalance in active eosinophils, Th1, Th2 and regulatory T cells

Abstract Background About one third of patients with Crohn’s disease (CD) develop strictures during their disease course requiring surgical resection. The immune landscape involved in this process is poorly understood. Therefore, we aimed to characterise the fibroblast phenotype, immune cells and their mediators involved in intestinal strictures. Methods We included 25 CD patients with stricturing disease in the terminal ileum (TI) and 10 controls with colorectal cancer (CRC), all undergoing an ileocolonic resection. Transmural samples from the resection specimen of the TI were obtained. Macroscopically, CD tissue was divided into unaffected, fibrostenotic and inflamed regions by an experienced histopathologist. Next, mucosa was separated from deeper layers, after which single cells were isolated and fluorescently stained for flow cytometry. Protein levels were determined via the MesoScale Discovery (MSD) platform in the corresponding samples. Comparisons between CRC controls and CD patients were performed via an unpaired t-test or Mann-Whitney analysis and corrected for multiple testing. Results An increase in active fibroblasts and decrease in inactive fibroblasts in the fibrotic and inflamed mucosa (p=0.0002 and p&amp;lt;0.0001) and deeper layers (p=0.003 and p=0.02) when compared to the CRC controls was observed, confirming ongoing tissue remodelling. An enrichment of active eosinophils was only seen in the fibrotic deeper layers (p=0.02), although an increase in T helper 2 (Th2) cells was observed in both the fibrotic and inflamed deeper layers (p=0.02 and p=0.04). In contrast, T helper 1 (Th1) cells were decreased in both fibrotic and inflamed mucosa (p=0.03 and p=0.02) and deeper layers (p=0.01 for both). Regulatory T cells were significantly enriched in both fibrotic and inflamed mucosa (p&amp;lt;0.0001 and p=0.0005) and deeper layers (p=0.01 and p=0.006) (figure 1). Protein quantification confirmed a significant increase in transforming growth factor-β3 (TGF-β3) in the fibrotic (p=0.007) and inflamed (p=0.0002) layers, but not in the more superficial mucosa. Comparably, IL-1β was increased in the fibrotic (p=0.05) and inflamed (p=0.05) deeper layers. A similar observation was made for basic fibroblast growth factor (bFGF) (p=0.004), although only a trend could be seen in the fibrotic deeper layers (p=0.08) (figure 2). Conclusion The fibrotic and inflamed tissue of CD patients is characterized by increased activated eosinophils, Th2 and regulatory T cells and decreased Th1 cells, as well as many of their mediator cytokines. The current immunological characterisation can help to prioritise potential anti-fibrotic targets for stricturing CD.

Mucosal Schwann cell hamartoma: a benign and little-known entity.

Dear editor, 50 years-old female with personal history of mutation of the gene BRCA1 and previous prophylactic double anexectomy consulted for rectal bleeding without pain since two weeks. A blood test was performed, with hemoglobin levels of 13.1g/dl and without iron deficiency. In the anal inspection there were neither external hemorrhoids nor anal fistulas, so a colonoscopy was requested. In the colonoscopy, all the colon mucosa was normal but, in the rectal retroflexion, apart from internal engorged hemorrhoids, surrounding the 50% of the anal opening an erythematous and indurated mucosa was found (figure 1). Biopsies were taken. The pathology report informed of proliferation of spindle-shaped cells exclusively in the lamina propria with eosinophilic cytoplasm and unclear cell borders (figure 2). Not nuclear atypia or mitotic activity were observed. On immunohistochemistry, S-100 protein was strongly positive (figure 3) and CD34, SMA, EMA and c-kit were negative. These results are concordant with the diagnosis of Schwann cells in the context of a mucosal Schwann cell hamartoma (MSCH). Given that these lesions seem to not have malignant potential, the patient was discharged without control colonoscopies. The episodes of rectorrhagia were attributed to the presence of internal hemorrhoids. Discussion: MSCH are benign and intramucosal tumors with a mesenchymal origin. They are most commonly located in the distal colon, but they were also found in the gallbladder, the esophagogastric union and in the antrum. They are observed most frequently in middle aged women (around 60 years-old) and they are generally asymptomatic. They are presented as polyps between 1 and 6mm, but in other cases they appeared as small whitish nodules, protruding lesions with normal superficial mucosa or even they were found in random biopsies of the colon. The MSCH are a rare entity with an unknown prevalence. Less than 100 cases are described in the literature. It is essential the differentiation between this entity and the Schwanomas or the gastrointestinal stromal tumors (GIST). Schwanomas are rare in the colon, they are well circumscribed (in contrast with the MSCH) and they are not limited to the lamina propria. GIST are more frequently located in the stomach and they are positive for c-kit. MSCH are not associated with hereditary syndromes such as neurofibromatosis and, in contrast with Schwanomas or GIST, they do not require surveillance because they are benign.

Postpolypectomy Syndrome Presenting with Small Bowel Obstruction

Postpolypectomy syndrome (PPS) results from an electrical current that is applied during a polypectomy that extends past the superficial mucosa, into the muscularis propria and serosa, resulting in a transmural burn and subsequent inflammation.

S2400 Granular Cell Tumor: A Rare Disease of Esophagus

Introduction: Granular cell tumors (GCTs) are rare, often benign tumors of neurogenic origin. GCTs are usually found incidentally but can present with dysphagia in symptomatic patients. They are diagnosed via biopsy and histology following an esophagogastroduodenoscopy( EGD). We present a case of a 46-year-old female who presented with dysphagia, GERD, and weight loss diagnosed with esophageal granular cell tumor following an EGD. Case Description/Methods: A 46 years old female with a past medical history of H. pylori gastritis presents with complaints of dysphagia for 3 months and GERD associated with weight loss. EGD reviewed a single 4 mm nodule found in the lower third of the esophagus with the appearance of a lipoma (Figure). Biopsy of esophagus nodule resulted in esophageal squamous epithelium with focal granular cell tumor; Immunohistochemistry tumor cells are positive for S100, CD56, CD68, negative for calretinin and AE1/3 supporting rare esophageal granular cell tumor. EUS demonstrated a 4.7 mm x 2.6 mm intramural (subepithelial) lesion appeared to originate from within the superficial mucosa (Layer 1), Patient underwent repeat EGD with en-bloc cap and band-assisted endoscopic mucosal resection (EMR) followed by 3 hemoclips placed for hemostasis. The patient was discharged home on a proton pump inhibitor. The patient reports clinical improvement on follow-up after 4 weeks. Discussion: GCTs are thought to originate from Schwann cells; the prevalence of GCTs is challenging to determine as there have been roughly 300 documented cases of GCTs discussed in the literature. Conversely, patients with larger diameter lesions typically present with indolent dysphagia and other less common symptoms such as gastro-esophageal reflux disease, dyspepsia, chest pain, cough, or nausea. GCTs on EGD appear sessile, yellow-white in color, and firm, with a negative pillow sign. After performing EGD, an endoscopic ultrasound (EUS) is diagnostically utilized to ascertain tumor invasion and provide a biopsy through fine needle aspiration (FNA). Histopathological diagnosis, including immunohistological staining, is essential for confirmation of GCT. Immunohistological staining is positive for S-100, PAS (Periodic Acid Schiff), neuron-specific enolase, nestin, and vimentin. Patients whose neoplasms are less than 1 cm in diameter are treated conservatively with endoscopic follow-up, with tumors greater than 1 cm in diameter, or having clinical symptoms that need endoscopic or surgical resection.Figure 1.: A: EUS showing 4.7 mm x 2.6 mm hypoechoic intramural (subepithelial) lesion was found in the lower third of the esophagus. It appeared to originate from within the superficial mucosa (Layer 1). A tissue diagnosis was obtained prior to this exam. B: EGD significant for sessile, yellow white in color, and firm mass followed by EMR. C: Histopathology with H&E showing clusters of polygonal cells with granular eosinophilic cytoplasm (top) and S100 stain (below).

S2310 Esophageal Manifestations of Paraneoplastic Pemphigus Vulgaris Associated With Gastric Neuroendocrine Tumor

Introduction: While pemphigus vulgaris (PV) typically affects the epidermis and oral mucosa, esophageal manifestations are uncommon. The primary symptoms accompanying this manifestation are dysphagia, odynophagia, and hematemesis. In this case report we examine the occurrence of esophageal pemphigus vulgaris associated with a gastric neuroendocrine tumor and note the endoscopic findings of esophagitis dessicans superficialis (EDS) within the esophagus. Case Description/Methods: A 63-year-old female with a history of P-ANCA vasculitis presented for evaluation of dyspnea, hypotension, fatigue, rash, and dysphagia. The patient was thought to have an infectious cause of these signs and symptoms, however given a lack of response to antibiotic and antifungal therapy within 48 hours the differential was broadened to include rheumatologic disease. The patient was treated with intravenous methylprednisolone and continued to experience dysphagia. Esophagogastroduodenoscopy was performed (Figure) and demonstrated a tongue ulceration and extensive desquamation in the distal esophagus appearing similar to a pseudomembrane. Extensive subepithelial hemorrhages were observed in the esophagus, however the gastric and duodenal mucosa were intact. Esophageal and gastric biopsies demonstrated staining for IgG reactive to desmoglein 3 consistent with PV. In addition, a well-differentiated neuroendocrine tumor (NET) in the stomach. The patient was subsequently treated with octreotide for her neuroendocrine tumor, as well as solumedrol and dapsone for her skin lesions. She also received a loading dose of rituximab. She received a second dose of rituximab 21 days after the loading dose and the corticosteroids were tapered as her symptoms of dysphagia gradually improved with immunosuppressive therapy. Discussion: Esophagitis dessicans superficialis has been described as sloughing of the superficial esophageal mucosa and is similar in appearance to the Nikolsky sign of external squamous epithelium seen with immunobullous diseases. Our patient presented with undiagnosed PV and had both esophageal and skin involvement with the concomitant gastric NET. The ultimate diagnosis of PV was confirmed based on the presence of antibodies to desmoglein 3 and it remains unknown if the gastric NET had any role in the development of PV. Clinicians should have a low threshold for endoscopic examination of patients for whom there is suspicion of immunobullous disease to facilitate rapid diagnosis and initiation of appropriate therapy.Figure 1.: Endoscopic images demonstrating tongue ulceration and extensive desquamation in the distal esophagus appearing similar to a pseudomembrane in addition to subepithelial hemorrhages.

S3716 A Rare Case of Ectopic Liver Tissue Incidentally Found in the Gastric Body

Introduction: Ectopic liver tissue (ELT) is seldom reported in the literature. It is usually asymptomatic and incidentally found. However, ELT has a strong association with malignant transformation to hepatocellular carcinoma (HCC), making removal of this tissue essential. Presented is a rare case of ELT found in the stomach. Case Description/Methods: A 78-year-old male with a past medical history of hypertension and gastritis presented to clinic for worsening gastroesophageal reflux disease (GERD) over the past six months. The patient reported GERD symptoms for the past twenty years that he had been self-treating with over-the-counter proton pump inhibitors, probiotics, and digestive enzymes without relief. On presentation his vitals, physical exam, and blood work were unremarkable. The patient underwent esophagoduodenoscopy (EGD) which revealed esophagitis, a large paraesophageal hernia, and a single 15-millimeter submucosal nodule in the anterior wall of the gastric body. Cold forceps biopsies obtained from the body and antrum of the stomach were unremarkable and negative for H. pylori. He was referred for endoscopic ultrasound (EUS), where a fine needle biopsy of the benign-appearing gastric body submucosal nodule was performed (figure 1a). Three passes were made with a 22-gauge ultrasound biopsy needle using a transgastric approach. A visible core of tissue was obtained. Final cytology demonstrated superficial gastric mucosa and detached benign liver tissue (figures 1b, 1c). No dysplasia or malignancy was seen. Discussion: ELT has an incidence of 0.24-0.47%. Of the reported cases, ELT is most commonly seen in the gallbladder or pancreas. The etiology of ELT is unknown but is thought to be associated with errors in embryological development. Most ELT is asymptomatic but can develop the same pathologies as the orthotopic liver. It can also cause abdominal pain, bleeding, and compression of neighboring tissues. There is also a strong association between HCC and ELT, necessitating biopsy and endoscopic removal. This case demonstrated ELT incidentally found in the gastric body during EGD and was biopsied by a fine needle using EUS guidance. Histology was without features to suggest malignancy, but to prevent malignant transformation endoscopic resection was recommended.Figure 1.: 1a. Arrow indicating nodule in gastric body, as seen by endoscopic ultrasound. Image 1b. Hematoxylin and eosin stain with 100x magnification. Normal gastric glandular mucosa. Arrow indicating benign unremarkable hepatic tissue found in gastric body. Image 1c. Hematoxylin and eosin stain with 200x magnification. Benign unremarkable hepatic tissue found in gastric body.

S1971 Waldenstrom Macroglobulinemia: A Malignant Mimicker of IBD

Introduction: Waldenstrom macroglobulinemia (WM) is a lymphoplasmacytic lymphoma in the bone marrow with IgM gammopathy in the blood. Annually ∼1400 cases are diagnosed in the US, with typical presentation of B symptoms, fatigue, neuropathy, and mucosal bleeding. Only 3% of patients present with colonic symptoms. We describe a case of WM with rectal involvement presenting as bloody diarrhea, mimicking inflammatory bowel disease (IBD). Case Description/Methods: A 56-year-old man with depression, anxiety, and fibromyalgia presented with 6 months of diarrhea with mucous and rectal bleeding. He underwent upper endoscopy and colonoscopy with Helicobacter pylori gastritis, proctitis, and inflammatory polyps. He symptoms worsened despite rectal mesalamine, including weight loss and night sweats. Budesonide oral and foam resolved the bleeding but diarrhea continued despite rifaximin. Around this time, he was thought to have irritable bowel syndrome. Two years later, he had recurrence of daily bowel movements with mucous and rectal bleeding, plus fecal incontinence, tenesmus, and rectal and abdominal pain. He also noticed myalgias, arthralgias, parasthesias, fatigue, and chills. Rheumatology suggested fibromyalgia as the culprit, in part due to elevated ESR. After his GI symptoms renewed suspicion for IBD, repeat colonoscopy showed a 3 cm rectal mass with ulcer and stenosis at the recto-sigmoid colon. Biopsies showed eosinophilic proteinaceous material positive for PAS-D, negative for fibrosis and amyloid and concerning for malignancy. EUS confirmed inflammatory polyps and rectal thickness ( Figure 1). Hematology performed immunofixation with faint monoclonal IgM-lambda, and bone marrow biopsy confirmed lymphoplasmacytic lymphoma concerning for WM. Discussion: WM rarely involves the GI tract, with fewer colonic and rectal presentations than small bowel. The IgM deposition can cause severe malabsorption, steatorrhea, obstructive symptoms, or GI bleeding. Especially in cases of bloody stools and localized colonic thickening, WM can be mistaken for IBD. In our case, factors more suggestive of WM included degree of colonic thickening and pathologic PAS-D positivity. Particularly, raised lesions should prompt investigation for malignant processes, despite surrounding inflammatory changes. Diagnosis of WM usually involves multiple specialists and procedures such as bone marrow biopsy. WM treatment includes bruton tyrosine kinase inhibitors or bendamustine with rituximab, the latter of which improved our patient’s GI symptoms.Figure 1.: Image 1. Colonoscopy and lower endoscopic ultrasound (EUS) visualized circumferential wall thickening and stenosis in rectum, with polyps and stenosis in sigmoid colon. a. During colonoscopy, a benign-appearing, intrinsic moderate stenosis measuring 4 cm in length was found in the recto-sigmoid colon, due to circumferentially congested edematous polypoid mucosa with overlying exudate. b. Several 10 to 16 mm sessile polyps were seen with inflammatory appearance in the sigmoid colon. c-d. During EUS, circumferential wall thickening was found in the rectum at the superficial and deep mucosa. There was no evidence of an infiltrative subepithelial mass. The muscularis propria layer was normal throughout.

Double troubleStrongyloidiasis hyper infection and intestinal tuberculosis co-infection-A rare case report

Strongyloidiasis, a human intestinal parasitic infection is most commonly caused by Strongyloides stercoralis species. Strongyloides Hyperinfection is an accelerated autoinfection occurring in immunocompromised state like tuberculosis, where increased number of infectious filariform larvae are produced. Here, we report a case of 35-year-old male, known case of intestinal tuberculosis, presenting with complaints of pain abdomen, associated with vomiting. Clinical and radiological examination revealed hollow viscous perforation with peritonitis. Surgical ileal resection with anastomosis was performed and histopathological analysis of the specimen revealed eggs and larval and adult forms of Strongyloides stercoralis within crypts and superficial mucosa

Gingival swelling and diffuse mandibular osteolysis in a 57-year-old woman

A 57-year-old woman was referred from her hematologist for evaluation of a left mandibular gingival swelling of 1 week's duration. The hematologist expressed concern about odontogenic infection owing to the patient’s prolonged immunosuppressive chemotherapy for the management of treatment-resistant multiple myeloma (MM). The diagnosis of MM had been made in 2017, and since then she had received multiple rounds of chemotherapy, undergone autologous stem cell transplantation, and received intravenous zoledronic acid (Zometa; Novartis). Her health history was also significant for type 2 diabetes mellitus, hypertension, and a distant history of mandibular orthognathic surgery. Results of the extraoral examination did not indicate any pathology. The intraoral examination revealed a firm, sessile, nonmobile, 1-cm mass on the buccal gingiva between teeth nos. 21 and 22 (Figure 1). The results of pulpal and periapical testing of adjacent teeth were unremarkable. No evidence of purulent drainage or hemorrhage from the lesion was seen. A cone-beam computed tomographic scan revealed multiple missing teeth in the maxillary and mandibular right quadrants as well as hardware in place from a bilateral sagittal split osteotomy. In addition, multiple ill-defined radiolucencies were notable across the mandible, with cortical perforation apparent in the anterior and left mandible (Figures 2 and 3) without evidence of tooth resorption or displacement. An excisional biopsy was performed of the gingival soft-tissue lesion in the area of teeth nos. 21 and 22 under local anesthesia. The histopathologic examination revealed a gingival soft-tissue lesion composed of an unremarkable superficial squamous mucosa with extensive and diffuse submucosal infiltrates of mature plasma cells (Figure 4). Immunohistochemical staining showed that the plasma cells were positive for cluster of differentiation 138, and in situ hybridization for κ and λ light chains showed that the plasma cells were κ-restricted (Figure 5). 1 O’Connell F.P. Pinkus J.L. Pinkus G.S. CD138 (syndecan-1), a plasma cell marker: immunohistochemical profile in hematopoietic and nonhematopoietic neoplasms. Am J Clin Pathol. 2004; 121: 254-263https://doi.org/10.1309/617DWB5GNFWXHW4L Crossref PubMed Scopus (214) Google Scholar Dr. Barawi is a resident, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL. Mr. Shah is a student, College of Dentistry, University of Illinois at Chicago, Chicago, IL. Dr. Cabay is an associate professor of clinical pathology, Department of Pathology, College of Medicine; a clinical associate professor, Department of Otolaryngology, College of Medicine; and an associate professor, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois Hospital, University of Illinois at Chicago, Chicago, IL. Dr. Callahan is an assistant professor, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL.