Type Of Inflammatory Reaction Research Articles

Post-treatment bacterial endocarditis mimicking fungal organisms: a morphologic comparison and tips for avoiding this diagnostic pitfall

BackgroundHistopathologic differentiation of bacterial endocarditis from yeast-like fungal endocarditis is usually straightforward; however, an underappreciated phenomenon is the effect of antimicrobial therapy on bacterial size, shape and septa (cross-wall) formation resulting in bacterial forms that mimic yeast-like fungi. In this article we illustrate the alterations that occur in antibiotic-treated Staphylococcus aureus endocarditis and compare these changes to histopathologic findings in unaltered S. aureus and Histoplasma endocarditis, respectively. MethodsResected valves from three cases of endocarditis were compared based on the type ofinflammatory reaction, organism morphology and culture results. Case 1 was S. aureus endocarditis initially misclassified as Histoplasma due to its atypical morphologic and histopathologic features. The two cases included for comparison were an S. aureus endocarditis with more classic features and an Histoplasma capsulatum endocarditis. Hematoxylin and eosin (H&E), Gram, periodic acid Schiff (PAS), Gomori-Grocott methenamine silver stains (GMS), and culture results were compared in all cases. Molecular and immunohistochemistry tests were used for confirmation of first case. High power oil-immersion was used to visualize organisms’ characteristics in all three cases. ResultsCase 1 and Case 3 (Histoplasma-infected valves) had fibrinous exudates with scattered macrophages. The microorganisms observed in the first case of methicillin-sensitive S. aureus (MSSA) were ∼ 2-3 μm by GMS stain and had prominent septations. Histoplasma yeast were round to oval, ∼ 3-4 μm in size and demonstrated budding. S. aureus without alterations were round, ∼ 1 μm in size, and lacked prominent septations. Necrotizing purulent inflammation was present in the unaltered case of MSSA. The MSSA case with alterations from antibiotic treatment did not stain well with the Gram stain and organisms were best visualized with the PAS and GMS stains. ConclusionsAntibiotic therapy for bacterial endocarditis can alter the inflammatory reaction to infection, bacterial size, septa formation, and staining characteristics. Knowledge of these therapy-related effects and use of high-power magnification helps to avoid misclassification as yeast-like fungi.

A case report of exogenous lipoid pneumonia associated with avocado/soybean unsaponifiables

BackgroundExogenous lipoid pneumonia is a rare disease resulting from intra-alveolar accumulation of lipids of mineral, vegetal, or animal origin, that induce a foreign body type of inflammatory reaction in the lungs. Gastroesophageal reflux disease and other esophageal abnormalities have often been associated with this disease.Case presentationWe herein report the case of an 83-year-old patient in whom a follow-up chest computed tomography scan, for a lingular consolidation, showed multifocal ground glass and consolidative opacities with areas of low attenuation, suggestive of exogenous lipid pneumonia. The patient had been on piascledine capsules (avocado/soybean unsaponifiables) for 20 years and had a hiatal hernia with documented gastroesophageal reflux disease. After thorough history taking, no other predisposing factors were found. The diagnosis was confirmed using oil red staining of bronchoalveolar lavage showing lipid-laden macrophages and extracellular lipid droplets.ConclusionsTo our knowledge, this is the first case of ELP secondary to avocado/soybean unsaponifiables in the literature.

TNFα and IL-17A are differentially expressed in psoriasis-like vs eczema-like drug reactions to TNFα antagonists.

Tumor necrosis factor α (TNFα) blocking drugs are in use for a wide range of autoimmune disorders. In up to 5% of patients, this class of drugs produces puzzling cutaneous side effects that are the subject of this investigation, namely psoriasiform and eczema-like skin inflammation. These side effects can occur after any time of treatment and regardless of the underlying disorders. The exact pathophysiology is as yet unknown. A total of 33 patients (19 female, average age 52 years) who had a cutaneous reaction to infliximab, adalimumab or etanercept were included. The type of inflammatory reaction was determined, and the corresponding cytokine expression was evaluated by immunohistochemistry for TNFα, IL-1β, IL-22, IL-6, IL-17A, IL33, IL-8 and IL-36α (semi-quantitative grading system from - to ++++). In addition, RNA expression levels of IL-17A and TNFα were confirmed by quantitative real-time PCR. IL-17A (P < .039) and TNFα (P < .008) were expressed at significantly higher levels in psoriasis or pustular-like reactions (PPR) compared to eczematous-like reactions (ELR). There was no significant difference in the expression of IL-1β, IL-22, IL-6, IL-33, IL-8 and IL-36α between PPR and ELR. TNFα and IL-17A are both cytokines known to be involved in psoriasis but less so in non-psoriasiform dermatitis or eczema. Therefore, their overexpression in PPR is plausible and suggests that the pathogenesis of PPR mirrors at least in part those of psoriasis. Further investigations will define the exact role of these cytokines in rare cutaneous side effects of anti-TNFα therapy. Our results suggest that IL-17A inhibition could be a therapeutic option in patients with anti-TNF induced psoriasis.

Biocompatibility of a New Dental Glass Ionomer Cement with Cellulose Microfibers and Cellulose Nanocrystals

Developing new restorative materials should avoid damage to tissue structures. This study evaluated the biocompatibility of a commercial dental glass ionomer cement (GIC) mechanically reinforced with cellulose microfibers (GIC+CM) or cellulose nanocrystals (GIC+CN) by implantation of three test specimens in subcutaneous tissue in the dorsal region of 15 Rattus norvegicus albinus rats. Each rat received one specimen of each cement, resulting in the following groups (n=15): Group GIC (Control), Group GIC+CM and Group GIC+NC. After time intervals of 7, 30 and 60 days, the animals were sacrificed and the following aspects were histologically evaluated: type of inflammatory cells, fibroblasts, blood vessels, macrophages, giant cells, type of inflammatory reaction and capsule thickness (µm). These events were scored as (-) absent, (+) light, (++) moderate and (+++) intense. The results were statistically analyzed by Kruskal-Wallis test and Mann-Whitney post test. At 7 days, Group GIC+NC showed more favorable tissue repair because quantitatively there were more fibroblasts (p=0.022), fewer macrophages (p=0.008) and mononuclear cells (p=0.033). Polymorphonuclear neutrophils and giant cells were absent in all experimental periods. At 60 days, test specimens in Group GIC+NC were surrounded by a fibrous tissue capsule with reduced thickness (26.72±2.87 µm) in comparison with Group GIC+CM (41.21±3.98 µm) (p=0.025). In general, all biomaterials showed satisfactory biocompatibility, but glass ionomer cement modified with cellulose nanocrystals showed a more advanced tissue repair.

Change humoral immunity in various types of inflammatory reactions in animals with gastroduodenit

Based on experimental research there were studied the changes of indicators of circulating immune complexes and different classes of immunoglobulin’s in the blood of animals gastroduodenitis in various types of inflammatory reactions. The study found that experimental animals are marked expressed violations of humoral immunity. In blood marked increase in the number of immunoglobulin’s and circulating immune complexes. The biggest changes were found in animals with hyperergic type of inflammatory reaction, the least – with hypoergic type, changes in animals with type normergic occupy an intermediate position.

Poly(D,L-Lactide-Co-Glycolide) Tubes With Multifilament Chitosan Yarn or Chitosan Sponge Core in Nerve Regeneration

The influence of different kinds of nerve guidance conduits on regeneration of totally transected rat sciatic nerves through a 7-mm gap was examined. Five different types of conduits made of chitosan and poly(D,L-lactide-co-glycolide) (PLGA) were constructed and tested invivo. We divided 50 animals into equal groups of 10, with a different type of conduit implanted in each group: chitosan sponge core with an average molecular mass of polymer (Mv) of 287 kDa with 7 channels in a PLGA sleeve, chitosan sponge core with an Mv of 423kDa with 7 channels in a PLGA sleeve, chitosan sponge core (Mv, 423 kDa) with 13 channels in a PLGA sleeve, chitosan multifilament yarn in a PLGA sleeve, and a PLGA sleeve only. Seven weeks after the operation, we examined the distance covered by regenerating nerve fibers, growing of nerves into the conduit's core, and intensity and type of inflammatory reaction in the conduit, as well as autotomy behavior (reflecting neuropathic pain intensity) in the animals. Two types of conduits were allowing nerve outgrowth through the gap with minor autotomy and minor inflammatory reactions. These were the conduits with chitosan multifilament yarn in a PLGA sleeve and the conduits with 13-channel microcrystalline chitosan sponge in a PLGA sleeve. The type of chitosan used to build the nerve guidance conduit influences the intensity and character of inflammatory reaction present during nerve regeneration, which in turn affects the distance crossed by regenerating nerve fibers, growing of the nerve fibers into the conduit's core, and the intensity of autotomy in the animals.

Change of humoral immunity indices in various types of inflammatory reactions in animals with gastroduodenit

Based on experimental research there were studied the changes of circulating immune complexes and different&lt;br /&gt;classes of immunoglobulins in the blood of animals gastroduodenitis in various types of inflammatory reactions.&lt;br /&gt;The study found that experimental animals are marked expressed violations of humoral immunity. The number of&lt;br /&gt;immunoglobulins and circulating immune complexes increased in blood. The biggest changes were found in animals&lt;br /&gt;with hyperergic type of inflammatory reaction, the least – with hypoergic type, changes in animals with type normergic&lt;br /&gt;occupy an intermediate position.

A Case of Gossypiboma Associated with Xanthogranulomatous Inflammation

A mass formed around a cotton matrix left within the body is termed as gossypiboma. It is a rare complication of surgery and often occurs mainly after abdominal operations. The incidence of gossypiboma is underreported, due to legal implications of their detection. Furthermore, a correct diagnosis can be made only in one-third of cases. Clinical presentation is variable, depending on the location of the foreign body and on the type of inflammatory reaction. The rec ommended choice of treatment is excision, with the most important consideration given to prevention. Xanthogranulomatous inflammation is an uncommon form of chronic inflammation, which is destructive to affected organs. To the best of our knowledge, we report the first case of gossypiboma associated with xanthogranulomatous inflammation. A gauze accidently left in the lateral neck after a neuro-surgical intervention was found during resection of mass-like lesion and xanthogranulomatous inflammation was diagnosed on histopathologic exam.

Notch signaling and new therapeutic options in liver disease

Notch signaling is a crucial determinant of cell fate decision during development and disease in several organs. Notch effects are strictly dependent on the cellular context in which it is activated. In the liver, Notch signaling is involved in biliary tree development and tubulogenesis. Recent advances have shed light on Notch as a critical player in liver regeneration and repair, as well as in liver metabolism and inflammation and cancer. Notch signaling is finely regulated at several levels. The complexity of the pathway provides several possible targets for development of therapeutic agents able to inhibit Notch. Recent reports have shown that persistent activation of Notch signaling is associated with liver malignancies, particularly hepatocellular with stem cell features and cholangiocarcinoma. These novel findings suggest that interfering with the aberrant activation of the Notch pathway may have therapeutic relevance. However, further studies are needed to clarify the mechanisms regulating physiologic and pathologic Notch activation in the adult liver, to better understand the mechanistic role(s) of Notch in liver diseases and to develop safe and specific therapeutic agents.

Resposta tecidual a implantes de discos de poliuretana de mamona nas formas pré-moldada ou biomassa moldada

O trabalho teve por objetivo avaliar a resposta tecidual à implantação de discos de poliuretana derivada do óleo de mamona confeccionados de duas formas distintas, na forma pré-moldada fornecida pela indústria e em biomassa moldada no momento da aplicação, de forma a observar se haveria algum tipo de reação local tardia associada à possível continuidade do processo de endurecimento final do biomaterial. Foram utilizados 20 ratos, linhagem Wistar, fêmeas, com peso de 300-350g, nos quais foi inserido o disco pré-moldado no tecido subcutâneo do flanco direito e o de biomassa moldada no flanco esquerdo. Ambos os discos tinham 0,8cm de diâmetro por 0,5cm de espessura. Para o procedimento histológico, cinco ratos foram submetidos à eutanásia aos 3, 7, 15 e 30 dias de pós-cirúrgico. Os implantes e tecidos circundantes foram colhidos, processados e corados pela técnica de hematoxilina-eosina. Foi observada inicialmente uma reação inflamatória moderada, composta especialmente por células polimorfonucleares e macrófagos. Os linfócitos variaram de ausentes a discretos. A reação inflamatória diminui de intensidade à medida que se intensificou a formação de tecido conjuntivo fibroso ao redor dos implantes, porém sem modificação dos números de macrófagos. Sendo assim, conclui-se que ambos os discos de poliuretana induzem uma reação inflamatória similar, que varia de moderada a discreta na dependência do momento de avaliação.

A influência da nicotina na densidade de colágeno em cicatrizes cutâneas, em ratos

To study the inflammatory reaction and deposition of collagen in the healing of cutaneous injuries under the influence of nicotine. The scars of abdominal injuries in rats were analyzed, which had been treated with nicotine, 2 mg/kg/d, and compared with those of control rats. Treatment was begun seven days prior to operation and was maintained for seven or fourteen days after surgery. The histological cuts were stained with hematoxylin and eosin and through the established scores the intensity and type of inflammatory reaction was identified. Histological cuts stained by Sirius Supra red F3BA enabled the identification of the collagen density. There was no difference in intensity of the inflammatory reaction after seven days (p=0.165), nor after fourteen days (p=0.684). There was no significant difference in the type I collagen density in the evaluation carried out after seven days (p=0.912) and after fourteen days (p=0,211). The control group had more type III collagen after seven days (p=0.004), but after fourteen days there was no significant difference (p=0.720). Although the total quantification of collagen was higher in the control group, there was no significant difference at any time during this study (p=0.103 after seven days and p=0.549 after fourteen days). In the scars of the animals treated with nicotine in comparison with the control group, there was no difference in the intensity of the inflammatory process, nor in collagen density.

Endoprótese revestida de jugular preservada de bovino: estudo comparativo da resposta tecidual em aorta torácica descendente e veia cava inferior de suínos

OBJETIVO: Avaliar e comparar a resposta tecidual de uma endoprótese biosintetica implantada na aorta torácica descendente e veia cava inferior de suínos. MÉTODO: Foi implantada uma endoprótese auto-expansível composta de aço inoxidável, revestida por veia jugular de bovino, processada pelo método L-hydro, com auxilio de uma bainha de liberação Taheri-Leonhardt (Flórida, EUA) na aorta torácica descendente, e a veia cava infra-renal de 10 suínos. Sessenta dias após, as endopróteses foram retiradas e analisadas sob o ponto de vista macro e microscópicos. Foram observados: perviedade, grau de incorporação a parede do vaso, tipo de reação inflamatória, e local de maior resposta, tanto em relação a camada do vaso quanto ao local de contato com o anel de aço RESULTADOS: Todas as endopróteses encontravam-se pérvias, e incorporadas à parede. No setor venoso, seis apresentaram traves fibrosas em sua luz, e quatro apresentaram fibrose perivascular. No setor arterial somente uma prótese apresentou discreta estenose, sem fibrose perivascular. A reação inflamatória crônica tipo corpo estranho ocorreu em 100% das peças, a camada média foi a mais acometida no setor venoso, enquanto a íntima foi mais constante na artéria, o grau de incorporação foi mais firme na veia em comparação a artéria. A reação tecidual mostrou maior tendência nas áreas em intimo contato com o anel de aço (intra-anelar), mais intensa na artéria do que na veia. CONCLUSÃO: A prótese apresentou baixa trombogenicidade em ambos os sistemas, houve maior reação tecidual e baixa biocompatibilidade no setor venoso.

Pathogenesis of B-Cell Superantigen-Induced Immune Complex-Mediated Inflammation

Staphylococcal protein A (SpA) is representative of a new class of antigens, the B-cell superantigens (SAgs). These antigens bind to the Fab regions of immunoglobulin molecules outside their complementarity-determining regions. SpA, the best-studied B-cell SAg, reacts with the Fabs of most VH3+ immunoglobulins, which are expressed on 30 to 60% of human peripheral B cells. Therefore, B-cell SAgs like SpA have great potential to elicit inflammatory responses in vivo. We previously reported that the interaction of SpA with VH3+ immunoglobulin molecules leads to activation of the complement cascade and produces a histologic pattern of inflammation in the skin of a rabbit indicative of immune complex injury. To elucidate the cellular and molecular events contributing to this type of unconventional immune complex-mediated inflammation, we established a mouse peritoneal Arthus reaction model. Mice treated intravenously with human polyclonal immunoglobulin G (IgG), followed by intraperitoneal injection of SpA, showed neutrophil influx into the peritoneal cavity with peak numbers appearing at 8 h. This inflammatory reaction was dependent on the interaction of SpA with VH3+ IgG. Mast cells, FcgammaRIII, complement components, and tumor necrosis factor alpha play obligatory roles, and the reaction is associated with the local release of the CXC chemokines macrophage inflammatory protein 2 and KC. The data provide further compelling evidence for the induction of immune complex-mediated injury by a B-cell SAg and highlight important factors contributing to the pathogenesis of this novel type of inflammatory reaction.

Granuloma and cryptococcosis

This review describes the general histopathological features of cryptococcosis in immunocompetent individuals, as well as in patients with acquired immunodeficiency syndrome (AIDS). Details of the histological examination of cryptococcal lesions are described, with the consideration of morphological modifications induced by treatment with highly active antiretroviral therapy (HAART). The essential histological features of cryptococcosis in individuals with impaired T-cell functioning are yeast-cell proliferation with a histiocytic response, but only minor lymphocytic and neutrophilic components. Several histological patterns of pulmonary cryptococcal lesions are introduced in this article, some of which could be graded with respect to the degree and type of inflammatory reaction. One pattern was a mild lesion consisting of scattered small foci of intraalveolar cryptococcal proliferation with a histiocytic response. Another pattern involved massive cryptococcal infection, which may have been simply more extensive than that in the mild lesion. Capillary involvement of alveolar septa should be understood as an important common finding in patients with AIDS who had not been treated with HAART. In those patients, the absence of T cells and a decreasing function of antigen-presenting activity in histiocytes were confirmed by immunohistological examination. These findings suggest that the lungs of AIDS patients without HAART offer little resistance to bloodstream dissemination by cryptococci. The unique histological feature demonstrated in patients treated with HAART is characterized by the presence of CD4+ cells, greater response of histiocytes and multinucleated giant-cell formation, and lack of massive capillary involvement.

Interstitial granulomatous pulmonary diseases: a diagnostic approach for the general pathologist

Some kinds of interstitial pneumonia present a histopathological pattern dominated by sarcoid - necrotizing or non-necrotizing - granulomas, which can be divided into two main groups: infectious and non-infectious. The infectious causes include tuberculosis, histoplasmosis, fungi in general, paracoccidioidomycosis, ascaridiasis, echinococcosis and dirophilariosis. The non-infectious causes include histiocytosis-X, hipersensitivity pneumonia, vasculitis, lymphomas, sarcoidosis, and pneumoconioses such as silicosis and berylliosis. The purpose of this review is to provide a practical guideline to enable general pathologists to make the differential diagnosis of granulomatous pulmonary diseases. For this purpose, anatomical-clinical-radiological correlations will be presented and targeted to each diagnosis discussed. Whenever a granulomatous inflammatory process is in progress, the search for infective agents by direct observation, by culture, and by histochemical methods should be mandatory. The histological aspects of infectious granulomas to be analyzed should include their random histo-anatomical location, the type of inflammatory reaction, and necrosis. A panel of complementary reactions (immunohistochemistry and PCR) should identify the infectious agent and, whenever their results and the culture are negative, the possibility of non-infectious granulomatous diseases has to be evaluated. In such cases, the histo-anatomical distribution (bronchocentric, lymphangitic, angiocentric, random), the qualitative characteristics of the lesions (type of necrosis and inflammatory reaction), and the correlation with the X-ray findings will help the diagnosis.

Mast cells mediate substance P-induced bladder inflammation through an NK1receptor-independent mechanism

The role of neurokinin-1 receptors (NK1R) in the interaction between mast cells and substance P (SP) in bladder inflammation was determined. Mast cell-deficient Kit(W)/Kit(W-v), congenic normal (+/+), and Kit(W)/Kit(W-v) mice that were reconstituted with bone marrow cells isolated from NK1R(-/-) mice were challenged by instillation of SP, antigen, or saline into the urinary bladder. Twenty-four hours after challenge, the bladders were prepared for morphological assessment and gene expression. SP-induced bladder inflammation was mast cell dependent and did not require NK1R expression on the mast cell. Cluster analysis identified functionally significant genes that were dependent on the presence of mast cells for their upregulation regardless of stimulus. Those include serine protein inhibitor 2.2, maspin, mitogen- and stress-activated protein kinase 2, and macrophage colony-stimulating factor 1. Our findings demonstrate that while mast cells are essential for both antigen- and SP-induced bladder inflammation, there are common genes and unique genes expressed in each type of inflammatory reaction. When combined with unique animal models, gene array analysis provides a useful approach for identifying and characterizing pathways involved in bladder inflammation.

Histopathology of deep-seated fungal infections and detailed examination of granulomatous response against cryptococci in patients with acquired immunodeficiency syndrome.

This understood without starting paper describes general histopathological features of deep-seated mycoses in patients with acquired immunodeficiency syndrome (AIDS) detailed histological examination on cryptococcal lesions with a consideration of morphological modification caused by treatment with highly active antiretroviral therapy (HAART). In a histopathological review of 164 patients with total human immunodeficiency virus (HIV) infection, the microscopical appearance of esophageal candidiasis which was common in those with single organ involvement revealed necrotic debris containing proliferating hyphae at the site of mucosal erosions without fungal invasion of underlying tissue. The incidence of oral and esophageal candidiasis was followed by that of pulmonary aspergillosis and Candida pneumonia. Nineteen patients including one treated with HAART had generalized cryptococcosis, representing the most common generalized fungal disease. The essential histologic features of the disease were yeast cell proliferation with a histiocytic response, but only minor lymphocytic and neutrophilic components. This was different from those induced by both Candida and Aspergillus infections. Three histologic patterns were recognized in the pulmonary cryptococcal lesions, two of which could be graded with respect to the degree and type of inflammatory reaction. The first was a mild one consisting of small scattered foci of intra-alveolar cryptococcal proliferation with a histiocytic response. The second pattern involved massive cryptococcal infection, which might have been simply more extensive than that in the former. Capillary involvement of alveolar septa was an important common finding in the eighteen patients who had not been treated with HAART. The absence of T cells and decreasing function of antigen-presenting activity in histiocytes were confirmed by immunohistological examination. These findings suggest that the lungs of AIDS patients without HAART offer little resistance to bloodstream dissemination by Cryptococci. The third pattern demonstrated in the patient treated with HAART was characterized by the presence of CD4+ cells, greater response of histiocytes and multinucleated giant cell formation, and lack of massive capillary involvement.

Matrix metalloproteinases and tissue inhibitors of metalloproteinases in cerebrospinal fluid differ in multiple sclerosis and Devic's neuromyelitis optica.

Matrix metalloproteinases (MMPs) are increased in the CSF of patients with multiple sclerosis. Devic's neuromyelitis optica (DNO) is a demyelinating syndrome that involves the optic nerve and cervical cord but differs pathologically from multiple sclerosis. Therefore, we hypothesized that the type of inflammatory reaction that causes MMPs to be elevated in multiple sclerosis would be absent in patients with DNO. CSF was collected from 23 patients with relapsing-remitting or secondary progressive multiple sclerosis, all of whom were experiencing acute symptoms, from seven patients with DNO, and from seven normal volunteers. Diagnoses were made according to current criteria on the basis of clinical manifestations, imaging results and CSF studies. IgG synthesis was increased in the CSF of multiple sclerosis patients but not in that of DNO patients. Zymography, reverse zymography and ELISA (enzyme-linked immunosorbent assay) were used to measure gelatinase A (MMP-2), gelatinase B (MMP-9) and tissue inhibitors of metalloproteinases (TIMPs). Zymograms showed that multiple sclerosis patients had elevated MMP-9 compared with DNO patients and controls (P: < 0.05). TIMP-1 and TIMP-2 levels were similar in all three groups. We conclude that multiple sclerosis patients have higher MMP-9 levels in the CSF than patients with DNO, which supports the different pathological mechanisms of these diseases.

Histopathology of cryptococcosis and other fungal infections in patients with acquired immunodeficiency syndrome

Objective: To gain insight into the histopathologic characteristics of fungal infection in acquired immunodeficiency syndrome (AIDS). Methods: A review was conducted of the histopathology for 162 patients with evident fungal infection. Results: The microscopic appearance of esophageal candidiasis that was common in patients with single organ involvement revealed necrotic debris containing proliferating hyphae at the site of mucosal erosions without fungal invasion of underlying tissue. The incidence of oral and esophageal candidiasis was followed by that of pulmonary aspergillosis and Candida infection. Eighteen patients had generalized cryptococcosis, representing the commonest generalized fungal disease. The essential histologic features of the disease consisted of yeast cell proliferation with a histiocytic response, but only minor lymphocytic and neutrophilic components. This was different from the manifestations of both Candida and Aspergillus infections. The two histologic patterns recognized in the pulmonary cryptococcal lesions could be graded with respect to the degree and type of inflammatory reaction. The milder one consisted of small scattered foci of intra-alveolar cryptococcal proliferation with a histiocytic response. Another pattern involved massive cryptococcal infection, which might be simply more extensive than that in the former. Capillary involvement of alveolar septa was an important common finding in all 18 patients. Conclusions: The absence of T cells and decreasing function of antigen-presenting activity in histiocytes were confirmed by immunohistologic examination. These findings suggest that the lungs in AIDS patients provide little resistance to blood stream dissemination by cryptococci.

The inflammatory response within Dukes’ B colorectal cancers: implications for progression of micrometastases and patient survival

OBJECTIVES: The aim of this study was to determine the relationship between the inflammatory response in primary colorectal carcinomas, patient outcome, and the fate of bone marrow micrometastases. METHODS: The populations studied were a) 155 consecutive patients with Dukes’ B colorectal cancer and follow-up for a mean of 5 yr, from the Mercy Hospital, Cork, and b) 260 consecutive patients with rectal carcinoma Dukes’ B and follow-up for >10 yr, from St. Mark’s Hospital, London. The primary tumor was assessed for the Jass and “Crohn’s-like” lymphoid reactions. In 36 consecutive patients, bone marrow aspirates were examined for micrometastases before and ≥6 months postoperatively. RESULTS: The relationship between prognosis and the inflammatory reactivity in the tumors was similar in both populations. In the Mercy group there were two deaths among 40 patients who had coexistent Jass and Crohn’s-like infiltrates. This contrasted with 25 deaths among 58 patients in whom both infiltrates were absent ( p < 0.005). Results were intermediate in cases in which either type of inflammatory reaction was present alone. In the St. Mark’s patients similar prognostic differences were sustained for up to 10 yr. Bone marrow micrometastases were present in 12/36 patients preoperatively and in 14/36 postoperatively. Seven of 12 patients with preoperative micrometastases were negative postoperatively, indicating clearance of tumor cells. Nine of 24 who tested negative preoperatively had micrometastases postoperatively. The clearance and presence of postoperative micrometastases was related to the immunological responses in the primary tumor. CONCLUSIONS: These results demonstrate an association between the inflammatory reaction, prognosis, and clearance of micrometastases, indicating a systemic antitumor reaction that confers a survival advantage.