Whitish Mass Research Articles

Gross, histologic, and ultrastructural features of iridophoromas in Siamese fighting fish (Betta splendens).

Pigment-containing and light-reflecting cell neoplasms, generically termed chromatophoromas, affect fish, reptiles, and amphibians. Chromatophoromas of light-reflecting cells are named iridophoromas. In this study, we aimed to describe the gross, histologic, and ultrastructural findings of 71 cases of iridophoromas in farmed Siamese fighting fish (Betta splendens). Macroscopically, iridophoromas appeared as whitish, gray, or black friable masses or plaques in the fin, trunk/tail, or head of the fish. Forty-five tumors (63%) were malignant and invaded the adjacent skeletal muscle and/or metastasized to other organs, whereas 26 (37%) tumors were restricted only to the skin, but due to the cytologic similarity to the malignant counterpart, we were not able to classify them as malignant or benign. Sixty-five (91%) tumors were classified as iridophoromas, whereas 6 (8%) were diagnosed as mixed chromatophoromas. Despite immunolabeling for PNL-2, melan A, or S-100 failing to demonstrate antigen expression, ultrastructural analysis identified light-reflecting neoplastic cells, unequivocally confirming iridophoromas as the predominant tumor. The high incidence of iridophoromas in Siamese fighting fish from the same breeding facility, coupled with a higher occurrence in royal blue and fancy copper color patterns and in young males, suggests a potential genetic/hereditary factor in the tumorigenesis of these neoplasms.

A case report on rare co-occurrence of invasive ovarian mucinous adenocarcinoma, unilateral renal agenesis, and bicornuate uterus: is it a new triad?

BackgroundConcomitant invasive ovarian mucinous adenocarcinoma, unilateral renal agenesis and bicornuate uterus is a rare combination. Unilateral renal agenesis has been associated with genital anomalies, such as unicornuate and bicornuate uterus. Furthermore, a wealth of studies has reported the association between unicornuate uterus and ovarian anomalies, such as the absence of an ovary or ectopic ovaries, but rarely has there been a combination of the three to the best of our knowledge. The present case report is the first case presentation with a combination of the three syndromes: ovarian mucinous tumor, unilateral renal agenesis, and bicornuate uterus.Case presentationWe report the case of a 17-year-old who presented with abdominal distension. On examination, a CT scan revealed a large multicystic abdominal mass on the right side, with an absence of the right kidney while the left kidney was normal in size, appearance, and position. Intraoperatively, massive blood-stained ascitic fluid was evacuated. Additionally, a large whitish polycystic intra-abdominal mass with mucus-like materials and solid areas was attached to the midpoint of the colon and the right ovary, with visible metastasis to the omentum. The uterus was bicornuate. The mass and omentum were taken for histopathology and a diagnosis of invasive ovarian mucinous cystadenocarcinoma with metastasis to the colon and omentum was made after a pathological report.ConclusionsThe presence of these conditions in the same individual could potentially complicate medical management and fertility considerations. Thus, a need for a multidisciplinary medical team, including gynecologists, urologists, and oncologists, to address their unique needs and provide appropriate treatment and guidance. Further research and case studies are needed to better understand the possible association and implications of these rare co-occurring conditions.

First Report of Golovinomyces bolayi Causing Powdery Mildew on Lettuce in Mexico.

In August 2022, powdery mildew symptoms were detected on lettuce (Lactuca sativa) in a commercial field located in Quecholac, Puebla, Mexico. Signs appeared as whitish powdery masses on leaves. Disease incidence was about 100% and signs covered up to 40% of leaf surface. Mycelium was amphigenous forming white patches. Hyphal appressoria were indistinct or nipple-shaped and solitary. Conidiophores (n= 30) were hyaline, erect, arising from the upper surface of hyphal mother cells or lateral, and of 90 to 201 μm long. Foot cells were cylindrical, of 49 to 92 × 10-15 μm, followed by 1-3 shorter cells, and forming conidia in chains. Conidia (n= 100) were hyaline, ellipsoid-ovoid, doliiform-subcylindrical, 27 to 40 × 14 to 20 μm. Conidial germination belonging to the Euoidium type. Chasmothecia were not observed. The morphological characters were consistent with those of Golovinomyces bolayi (Braun et al. 2019). A voucher specimen was deposited in the Herbarium of the Department of Agricultural Parasitology at the Chapingo Autonomous University under accession number UACH451. To confirm the identification of the fungus, genomic DNA was extracted from conidia and mycelium following the CTAB method (Doyle and Doyle 1990), and the internal transcribed spacer (ITS) region was amplified by PCR using the primers ITS5/ITS4 (White et al. 1990) and sequenced. The resulting 506 bp sequence had 100% identity to those of G. bolayi (LC417109 and LC417106). Phylogenetic analyses using the Maximum Likelihood and Maximum Parsimony methods were performed and confirmed the results obtained in the morphological analysis. The isolate UACH451 grouped in a clade with isolates of G. bolayi. The ITS sequence was deposited in GenBank under accession number OR467546. Pathogenicity was confirmed by gently dusting conidia onto ten leaves of healthy lettuce plants. Five non-inoculated leaves served as controls. The plants were maintained in a greenhouse at 25 to 30 ºC, and relative humidity of 70%. All inoculated leaves developed similar symptoms to the original observation after 10 days, whereas control leaves remained disease free. Microscopic examination of the fungus on inoculated leaves showed that it was morphologically identical to that originally observed. Based on morphological data and phylogenetic analysis, the fungus was identified as G. bolayi. This pathogen has been previously reported causing powdery mildew on lettuce in Argentina, Canada, Chile, Ecuador, Peru, USA and Venezuela (Braun et al. 2019; Mieslerová et al. 2020). To our knowledge, this is the first report of G. bolayi causing powdery mildew on lettuce in Mexico.

Ethmoidal Sinonasal Angioleiomyoma: A Rare Case With A Diagnostic Challenge

Sinonasal Angioleiomyomas are rare benign mesenchymal tumours consisting of well differentiated smooth muscles proliferation with vascular component that represent less than 1 percent of all the vascular leiomyomas. The most effective way of detecting sinonasal angioleiomyoma preoperatively is by computed tomography however the postoperative histopathological remains the gold standard in diagnosis of vascular leiomyomas. In this case report we present a case of 45 years old female with positive history of nasal obstruction, epistaxis, hyposmia and facial pain. Physical examination revealed whitish mass in both nasal cavities with decrease nasal patency in both nostrils. After endoscopic resection, the diagnosis of sinonasal angioleiomyoma was established based on histopathology. Since ethmoidal sinuses are relatively uncommon area for the sinonasal angioleiomyomas to occur therefore we suggest that one should keep them in mind when making differential diagnosis of nasal obstruction with epistaxis. It is also worth noting that this is the first reported case of sinonasal angioleiomyoma arising from the ethmoidal sinuses from Pakistan.

Middle ear neuroendocrine tumour-case report of a rare tumour of the temporal bone

Several conditions are known to present as masses in the middle ear medial to an intact tympanic membrane. Reddish masses that blanch on seigelization are usually paragangliomas. Sometimes, a high rising jugular bulb or an aberrant carotid artery can also be seen. Whitish masses are usually congenital cholesteatomas, tympanosclerosis, cartilage grafts that have been surgically placed, and rarely middle ear adenomas (MEA). An elderly male presented with decreased hearing, which was revealed to be secondary to a pale mass in the middle ear, displacing the intact tympanic membrane laterally. He underwent biopsy followed by complete excision of the mass, with preservation of the intact ossicular chain. There no evidence of recurrence on follow-up. Histopathology revealed the mass to be a MEA, also known as middle ear neuroendocrine tumour (MeNET). Middle ear neuroendocrine tumours are rare tumours. We describe the clinical presentation and management of this tumour.

Osteosarcoma in a free-living yellow armadillo (Euphractus sexcinctus)

An adult male free-living yellow armadillo (Euphractus sexcinctus) was found by hunters and referred for clinical evaluation because of a tumour-like lesion on the carapace. The animal was lethargic and weak with severe dehydration, enophthalmos and cachexia, and was euthanized because of its very poor clinical condition. Necropsy revealed a whitish, exophytic, irregular and moist mass (7 × 6.5 × 1.5 cm) in the caudal third of the carapace. On cut section, the mass was hard, compact, irregular and whitish. Histopathology revealed a densely cellular, expansive, poorly delimited neoplasm composed of malignant mesenchymal cells arranged in islands and cords, interspersed by numerous areas of irregularly mineralized osteoid matrix. Neoplastic cells were intensely immunolabelled for vimentin. The diagnosis of a high-grade osteosarcoma of osteoblastic subtype was based on the clinical, gross, histopathological and immunohistochemical findings. This first report of an osteosarcoma in an armadillo expands the list of armadillo diseases and will assist the management of these animals by veterinarians.

First Report of Diaporthe fusicola Causing Postharvest Fruit Rot of Peach (Prunus persica) in China.

In May 2022, rot symptoms were observed on postharvest peach (Prunus persica [L.] Batsch) fruits in a market in Nanchang, Jiangxi province (28°44' N; 115°50' E), China. A total of 80 samples were collected from three different fruit stalls through the market survey. The incidence of this disease was 10 to 15%, and severity varies from approximately 30 to 50% of fruit surface coverage. The symptom of infected fruits was circular, pale brown to brown, rotten, necrotic lesions, covered with white hyphae and small spore masses. Eight symptomatic peach fruits were surface disinfected with 75% ethanol for 30 sec and incisions were made with a sterile scalpel. Small pieces from symptomatic tissues were placed on a potato dextrose agar (PDA) medium and incubated at 25℃ for 7 days. Six isolates were obtained in total. Colonies on PDA were initially white, aerial, fluffy at first, and darkened with age. Alpha conidia were fusoid, hyaline, aseptate, guttulate, tapering towards ends, and ranged in size from 9.8 to 5.1 µm × 3.2 to 2.1 µm (x ̅=7.1 ± 1.0 × 2.6 ± 0.3 µm, n=60). Beta conidia were not seen. For further confirmation, genomic DNA was extracted from three isolates (04-10, 04-11, and 04-12), the internal transcribed spacer (ITS) region, beta-tubulin (TUB), calmodulin (CAL), partial translation elongation factor 1-alpha (TEF1-α) and histone H3 (HIS) genes were amplified by using primers ITS1/ITS4, Bt2a/Bt2b, CAL228F/CAL737R, EF1-728F/EF1-986R, CYLH3F/H3-1b (Udayanga et al. 2015), respectively. Sequences were deposited in GenBank (Accession Nos. ON994257 to ON994259 for ITS, OP076824 to OP076826 for TUB, OP076827 to OP076829 for CAL, OP076821 to OP076823 for TEF1-α, OP076830 to OP076832 for HIS). BLAST results showed that ITS and TEF1-α have 99.8% pairwise identity to Diaporthe fusicola (MN816432, KF576256), and the TUB, CAL, and HIS sequences also have 100% pairwise identity to D. fusicola (KF576287, MT978147, MT978142). Phylogenetic analyses of concatenated sequences using Bayesian inference and the maximum likelihood confirmed the identity. To verify Koch's postulates, the pathogenicity of three isolates was tested on harvested healthy peach fruits. Five surface-sterilized fruits were wounded by a sterile scalpel and inoculated with 5-mm-diameter mycelial plugs from 10-day-old PDA plates. Another set of five fruits was inoculated with sterilized PDA plugs as controls. All fruits were incubated at 26℃ with 80% relative humidity. The experiment was repeated three times. After 5 days, the fruit inoculated with mycelial plugs showed pale brown lesions with whitish mycelium mass, similar to the previous rot symptoms, whereas the control fruit remained symptomless. The same pathogen was reisolated from the inoculated fruit with symptoms and identified as D. fusicola by molecular techniques, but never from the control. Diaporthe fusicola (Diaporthe amygdali complex) was first described on leaves of Lithocarpus glabra in China (Gao et al. 2015) and reported as an agent causing leaf blotch on Osmanthus fragrans (Si et al. 2020) and pear shoot canker (Guo et al. 2020). However, this is the first report of D. fusicola causing postharvest fruit rot on peach. The managers involved must consider the impact of this disease and develop an effective fruit storage strategy.

Hyperplasia of Arachnoid Trabecular Cells: A Hitherto Undescribed Lesion Observed in the Setting of Neurofibromatosis Type 1.

Central nervous system manifestations, a variety of benign and malignant tumors as well as non-neoplastic abnormalities, are found in over 70% of neurofibromatosis type 1 (NF1) patients. Herein, we report hitherto undescribed space-occupying lesions in the setting of NF1. We aimed to clarify their characteristics, especially whether they represent neoplastic or non-neoplastic (hyperplastic) lesions. All 3 cases were preoperatively assessed as non-neoplastic; 2 and 1 cases were suspected to be arachnoid cysts and dilation of subarachnoid space, respectively. However, all lesions were revealed to be whitish jelly-like masses by operation, and the histology composed of spindle cells resembling arachnoid trabecular cells with moderate cellularity and cellular uniformity gave an impression that these lesions may be neoplastic. In contrast, electron microscopic analysis showed that the characteristics of these cells were compatible with those of normal arachnoid trabecular cells. Furthermore, whole-exome sequencing and array comparative genomic hybridization did not show any obvious alterations suggestive of their neoplastic nature. DNA methylation analysis demonstrated that these lesions were epigenetically distinct not only from meningiomas but also from normal healthy meninges. In conclusion, considering the clinicopathologic aspects of the present lesions and the results of the molecular analysis that failed to suggest their neoplastic nature, they may represent previously unrecognized rare hyperplasia of arachnoid trabecular cells, which may be associated with NF1.

TUBERCULOSIS OF THE UROGENITAL AND CENTRAL NERVOUS SYSTEMS COMPLICATED WITH SEPTIC SHOCK: LESSONS LEARNED FROM A RESOURCE-LIMITED SETTING

The incidence of tuberculosis (TB) infection in multiple organs outside the lungs is of particular concern. We present the case of a 48-year-old woman with a history of pulmonary TB who had a gradual loss of consciousness in one day, worsening shortness of breath, and a cough with green phlegm two weeks before admission. She had been undergoing five days of TB treatment with the drug-sensitive TB treatment regimen. The genital examination revealed a whitish mass in the paraurethral area, which impaired her urination. Blood gas analysis showed respiratory acidosis, and a chest X-ray suggested pulmonary TB and concurrent community-acquired pneumonia. She was diagnosed with extrapulmonary tuberculosis (EPTB) in the central nervous systems and urogenital sites. To treat her lifethreatening EPTB, she received crystalloid infusions, oxygen supplementation, ampicillin-sulbactam (converted to meropenem the next day), an oral fixed-dose combination antituberculosis therapy, pyridoxine, N-acetylcysteine, ursodeoxycholic acid, Curcuma, bisoprolol, proton pump inhibitor, and antiemetics. Additionally, she was inserted with a urethral catheter and a nasogastric tube to assist her urination and nutritional intake. Our facility was a subdistrict hospital and had a limited capacity for diagnosing and treating EPTB due to a lack of advanced intensive care units, blood and sputum cultures, and laboratory panels. After her two-day hospital admission to ICU for stabilisation, she was referred to a higher-level hospital with more advanced pulmonary treatment overseen by a multidisciplinary team. Our resource limitations highlight the importance of being

Esophageal squamous cell papilloma in a child with cystic fibrosis: A rare incidental endoscopic finding

Esophageal squamous cell papilloma is an uncommon epithelial lesion of the esophagus. Epidemiological data regarding esophageal squamous cell papilloma in children is scarce and consists of few case reports. Although the etiology of esophageal squamous cell papilloma remains unclear, chemical/mechanical irritation induced hyper-regenerative response of esophageal mucosa and human papillomavirus infection have been suggested as most probable causes. A case of a 14-year-old girl with cystic fibrosis and chronic dyspepsia had a 0.5 x 0.5 cm sessile, multilobulated, whitish and verrucous polypoid mass close to the lower esophageal sphincter removed. Histologically, a benign squamous papilloma was confirmed. Her dyspeptic symptoms suggestive for gastroesophageal reflux resolved after papilloma removal and anti-acid treatment. Esophageal squamous cell papilloma is an incidental finding at upper endoscopy. Gastroesophageal reflux disease may be responsible for distally localized papillomas. Due to its rarity in childhood, there are not any well-established management and surveillance guidelines. Esophageal squamous cell papilloma should be removed, when possible, because of the ambiguity about its malignant potential.

First Report of Erysiphe betae Causing Powdery Mildew on Chard (Beta vulgaris var. cicla) in Mexico.

Chard (Beta vulgaris var. cicla; Chenopodiaceae) is a vegetable native to the Mediterranean, widely cultivated for its nutritional properties. In June 2020, an outbreak of powdery mildew was detected in a commercial crop of chard in San Martín Texmelucan, Puebla (19°14'37.1"N; 98°27'12.5"W), Mexico. The disease was present in 86% of the plants (n=400) and the pathogen was found to cover up to 95% of the surface of the leaves. Initially, small whitish patches were observed on both sides of the leaves. Subsequently, the patches grew rapidly to cover most of the leaf surface and premature senescence of infected leaves was observed. The signs of the pathogen were observed as abundant whitish masses of conidia. Microscopic analysis of the fungus showed amphigenous mycelia with lobed hyphal appressoria. Conidiophores (n=30) were simple and erect, 93133 × 7.58.5 μm. Foot cells (n=30) were cylindrical, predominately straight, and rarely somewhat curved at the base, 30.036.5 μm, followed by a longer cell and two shorter cells, and the conidium. Conidia (n=100) were hyaline, ellipsoid-ovoid, 3745 × 1416 μm. Germ tubes (n =30) were terminal, short (0.52.0 times the conidial width) and stout. Conidial appressoria (n=30) were mostly lobed, showing from 2-6 lobes. Chasmothecia were not found. The morphological characteristics observed correspond to previous descriptions of Erysiphe betae by Braun and Cook et al. (2012). A voucher specimen (accession no. UACH450) was deposited in the Department of Agricultural Parasitology Herbarium at the Chapingo Autonomous University. To confirm identification, DNA was extracted from the fungus, and the internal transcribed spacer (ITS) and the 28S gene region of rDNA from one sample were amplified by PCR, using the primers ITS1/ITS4 (White et al. 1990) and PM3 (Takamatsu and Kano 2001)/TW14 (Mori et al. 2000). The sequences obtained from our specimen were registered to the GenBank under the accession numbers ON157053 and ON157047 for ITS and LSU, respectively. Our sequences shared 100% identity for ITS (KX574674) and 99.8% for LSU (OM033348 and OM368494) with sequences of E. betae in BLAST'n search. Based on phylogenetic analysis using the Maximum Likelihood method including a published ITS + 28S dataset for Erysiphe species, the isolate UACH450 was grouped into a clade with E. betae. Takamatsu et al. (2015) found that E. betae, E. malvae and E. heraclei are phylogenetically indistinguishable (they form the E. heraclei species complex), nevertheless, E. malavae infects Lavatera and Malva (Malvaceae), E. heraclei predominately forms on hosts of Apiaceae and E. betae is commonly found on Beta and Chenopodium (Chenopodiaceae) (Braun and Cook 2012). Pathogenicity was verified by spraying a suspension of conidia (1107 conidia/ml) onto the leaves of six healthy chard plants and six plants were sprayed with sterile distilled water to serve as controls. All plants were maintained at temperatures from 28 2 °C and relative humidity of 802 %. All inoculated leaves developed powdery mildew symptoms after 14 days, whereas the control plants remained symptomless. The pathogenicity test was performed twice, observing the same results. The recovered pathogen showed the same morphological characteristics as the inoculated pathogen, thus fulfilling Koch's postulates. To our knowledge, this is the first report of Erysiphe betae causing powdery mildew on Beta vulgaris var. cicla in Mexico. This pathogen has been previously reported in Iraq (Amano, 1986) and Greece (Vakalounakis and Kavroulakis, 2017) on Beta vulgaris var. cicla. Also, Erysiphe betae has been reported in Mexico on Chenopodium and throughout the world on sugar beet (Farr and Rossman, 2022). This pathogen is a major issue as it can completely cover the leaves of the diseased plants, making them difficult to market.

First Report of Postharvest Fruit Brown Rot Disease on Navel Orange Caused by Diaporthe sojae in China.

In October 2020, a postharvest fruit brown rot symptom was observed on navel orange (Citrus sinensis Osbeck cv. Newhall) fruits in a local fruit market in Ganzhou, Jiangxi Province, China. The disease incidence increased up to 15% in 40 fruits with a 7-day-long storage at room temperature. The disease symptoms on the infected fruit were circular, light brown to brown, slightly sunken lesions, covered with whitish mycelium mass, and brown rot in the center. To isolate the causal organism, infected fruits were surface sterilized with 1% NaClO solution for 30 sec, and rinsed thrice with sterilized water. Symptomatic tissues at the margins were cut into 5-mm2 pieces, placed on potato dextrose agar (PDA) medium and incubated at 25℃ for 5 days. Thirteen morphologically similar single-spore fungal isolates were obtained from the isolation experiment. Fungal colonies were white, fluffy, cottony texture, reverse buff to light yellow, with black stromata at maturity. Alpha conidia were hyaline, aseptate, ellipsoid to clavate, tapering towards the ends, often biguttulate, and ranged in size from 6.8 to 9.8 µm × 2.7 to 4.5 µm (n=50). Beta conidia were hyaline, aseptate, smooth, straight to sinuous, and with size ranging from 12.1 to 21.3 µm × 0.9 to 2.2 µm (n=50). Morphological features were consistent with those of Diaporthe sojae (Dissanayake et al. 2015). For molecular identification, DNA was extracted from the representative isolate JFRL 03-13, the internal transcribed spacer (ITS) region, beta-tubulin (TUB), calmodulin (CAL), partial translation elongation factor 1-alpha (TEF1-α), and histone H3 (HIS) genes were amplified by using primers ITS1/ITS4, Bt2a/Bt2b, CAL228F/CAL737R, EF1-728F/EF1-986R, and CYLH3F/H3-1b (Udayanga et al. 2015), respectively. The resulting sequences were deposited in GenBank (Accession Nos. OM281710 for ITS, OM289961 for TUB, OM289964 for CAL, OM289963 for TEF1-α, and OM289962 for HIS). BLAST analysis revealed that these sequences were 100% similar to the sequences of ITS (MN816426), TUB (MK941336), CAL (MN894375), TEF1-α (MN894447), HIS (MN894409) published for D. sojae. Phylogenetic analysis was conducted based on the concatenated sequences (ITS, TUB, CAL, TEF1-α, and HIS) by Maximum likelihood analysis (ML) and Bayesian inference (BI) using IQtree v.1.6.11 and MrBayes v.3.2.7 (Guo et al. 2020). The phylogenetic tree showed that the isolate clustered with D. sojae. To confirm pathogenicity, mature and healthy harvested fruits of navel orange (Citrus sinensis Osbeck cv. Newhall) were surface sterilized. Ten fruits were wounded by a sterile scalpel and put a 7-mm-diamter agar plug with 7-day-old mycelium of the isolate JFRL03-13 cultured on PDA at 25°C, noncolonized PDA plugs were used as the control. Inoculated fruits were incubated at 25℃ with 80% relative humidity. After 10 days, the similar symptoms were observed on the inoculated sites and spread on the surface of fruits, whereas the control remained symptomless. The pathogen was re-isolated from the lesions of inoculated fruits and confirmed as D. sojae via morphological and molecular analysis. The assays were repeated twice, fulfilling the Koch's postulates. Although D. sojae is known as the major causative agent of pod and stem blight, and has been reported as an endophyte in the twigs and leaves of citrus (Huang et al. 2015; Santos et al. 2011), but to our knowledge, this is the first report of postharvest fruits brown rot disease on navel orange caused by D. sojae in China. However, further investigation of the specific causes of this disease is necessary to help the local fruit farmers develop effective disease management strategies.

Intratympanic membrane cholesteatoma after traumatic tympanic membrane perforation: a case report

BackgroundIntratympanic membrane cholesteatoma presents as an asymptomatic, white, round mass on the tympanic membrane, and is usually detected incidentally in children.Case presentationA 12-year-old Korean boy visited our otorhinolaryngology clinic for a whitish mass on the right tympanic membrane. He had a history of traumatic tympanic membrane perforation in the right ear that had occurred 1 year prior, which had healed well with a paper patch placement. The mass was completely removed under local anesthesia during surgery with a microscope. The mass was on the outer epithelial layer of the right tympanic membrane and did not invade the middle fibrous and inner mucosal layers. Cholesteatoma was diagnosed on the basis of histopathology.ConclusionIntratympanic membrane cholesteatoma may not induce symptoms or invade the middle ear because it can grow outwards into the external auditory canal. However, intratympanic membrane cholesteatoma can grow over time, and then after growth, it can compress the tympanic membrane and advance into the middle ear, which can cause symptoms such as hearing loss. Intratympanic membrane cholesteatoma in children should be carefully evaluated and followed, and surgical removal should be considered, even for asymptomatic cases, to minimize potential damage and hearing loss.

Painful facial, oral, and genital ulcers

Painful facial, oral, and genital ulcers

Prenatal and postnatal peculiarities and consequences of intestinal loop patency disorder with expansive giant cystic abdominal mass in a preterm newborn.

To analyse the findings in a newborn (36 gestational weeks, birth weight: 4,030 grams, birth length: 48 cm, Apgar score 7/8/8 points) with prenatal suspicion of intestinal obstruction at the duodenum/jejunum level. The patient required urgent surgery on the first day of life. Examination of the abdominal cavity confirmed the presence of a cystic mass with a volume of approximately 800 ml, which was located at the site of jejunal atresia. As part of the surgical solution, the cystic formation and the atretic segment of the intestine were resected with subsequent end-to-end jejuno-jejunal anastomosis and Bishop‒Koop ileostomy. The histological examination of 3 samples collected confirmed the presence of mucous membrane and smooth muscle. The cyst anatomically communicated with the aboral section of the jejunum, but the lumen of the jejunum was functionally obturated by solid whitish masses. The histological examination confirmed the diagnostic features of a cyst of intestinal origin. The ileum and colon were patent throughout, but of smaller diameter, so a Bishop-Koop relieving anastomosis was indicated. The condition of the child at the age of 9 months was stabilised and surgical closure of the stoma was carried out (Tab. 1, Fig. 8, Ref. 21). Text in PDF www.elis.sk Keywords: newborn, jejunal atresia, intestinal cyst.

Myointimoma (angiocentric myofibroblastic tumor) of the glans penis in an adolescent: a case report and review of the literature

BackgroundSoft tumors of the penis are extremely rare in childhood and adolescence. Because there are no guidelines, each such case raises embarrassment over the extent and degree of aggressiveness of the diagnostic and therapeutic procedures. Herein, we describe a case of a teenager with a penile myointimoma along with a review of the literature. So far, only 10 cases have been reported in this age group.Case presentationThe 15-year-old boy presented with a 6-months history of a slowly growing, palpable firm nodule in glans penis. Physical examination revealed a palpable, well circumscribed, firm, whitish painless mass, around 1 cm in diameter within the glans. Ultrasound revealed hypoechogenic, hypoperfused poorly defined area inside the glans. MRI did not confirm any other pathologic mass inside the glans and corpora cavernosa. An excisional biopsy was performed; its immunohistological features indicated myointimoma.Discussion and conclusionGiven the rarity of this benign entity, the main importance is to distinguish myointioma from more clinically aggressive neoplasms. The key to a correct diagnosis is a careful histological examination, including immunohistochemistry. Local excision is safe and effective treatment modality.

ODP593 Thyroid sarcoidosis: case study and literature review

Abstract Introduction Sarcoidosis is a disorder characterized by noncaseating granulomas, most commonly in the lungs, lymph nodes, and skin. Patients often present with cough, skin or eye changes, enlarged lymph nodes, fatigue, or are found to have incidental findings on chest imaging. While any organ can be involved, thyroid involvement is rare, reportedly seen postmortem in 4.2 to 4.6% of sarcoidosis cases. We describe the case of a young adult male with thyroid sarcoidosis in addition to neurosarcoidosis. Case Presentation A 37-year old African American male was found to have a goiter on routine examination. Work up revealed an elevated TSH level of 11.1 uIU/mL (0.4-4. 0) with a free T4 of 0.91 ng/dL (0.7-1.9). Thyroid ultrasound demonstrated a dominant right-sided thyroid mass measuring 5.5×3.1×4.1 cm. Fine needle aspiration cytology reported polymorphic lymphocytes, few lymphohistiocytic aggregates, scant hurthle cells, and multinucleated giant cells. Thyroidectomy was recommended; intra-operatively the right thyroid lobe contained a 5-cm firm, hard, whitish mass in the mid inferior portion which could not be excised due to extensive fibrosis. Incisional biopsy was performed demonstrating fibrotic lymphocytic thyroiditis and non-caseating granulomas with no evidence of malignancy. He presented to the ER six weeks later with confusion, headaches, retro-orbital pain, and periodic involuntary movements in all extremities. MRI of the brain showed dural-based lesion in the right lateral and inferior temporal fossa. He underwent craniotomy and excisional biopsy of the lesion, which showed granulomatous inflammation, favoring a diagnosis of neurosarcoidosis. In a future admission, he was found to have dural venous sinus occlusion and new granulomas on brain MRI. It was then noted that previous thyroid biopsy revealed granulomatous disease, which was then linked to his sarcoidosis. He was discharged on prednisone and methotrexate with eventual further neurological complications. Discussion Thyroid sarcoidosis is very rare and because of this, it is frequently misdiagnosed initially and fine needle aspiration of the thyroid is frequently nondiagnostic. Histopathology is usually necessary to rule out malignancy and identify non-caseating granulomas. In some reported cases, thyroid sarcoidosis shared clinical, ultrasonographic, and even cytologic features with papillary thyroid cancer. Our case was unique for several reasons. Firstly, although not immediately noted, incisional thyroid biopsy was the first diagnostic clue of sarcoidosis. More commonly, patients are already diagnosed with systemic sarcoidosis. Additionally, typical findings such as mediastinal hilar adenopathy, hypercalcemia, and elevated angiotensin converting enzyme levels were absent. Although sarcoidosis of the thyroid is rare and often benign, it is important to consider this differential diagnosis while ruling out more likely causes as early detection can lead to early treatment and prevent adverse outcomes. The ideal treatment remains unclear, regarding whether to treat pharmacologically or concurrently with surgical intervention. Presentation: No date and time listed

Congenital cholesteatoma: a review

Congenital cholesteatoma (CC) is a whitish mass lesion found in the middle ear cleft behind the intact tympanic membrane in early life. It is a relatively uncommon disease and shows its growth and extension over a period of time. CC is evidenced with no prior history of tympanic membrane perforation, otorrhea, previous otologic procedures, normal pars tensa, and pars flaccida. The etiopathogenesis of CC is still controversial; however, the epithelial cell rest theory is the most commonly accepted one. The most common sites of CC are the anterior-superior and posterior-superior quadrants of the tympanic cavity. The most common clinical presentation of CC is conductive hearing loss. Early detection and intervention are needed to avoid the complications of CC. The treatment of choice in CC is still surgical. The frequency of recurrence seems to be lower in patients with CC than in acquired cholesteatoma. Rapid progression of the CC may occur in older children and the recurrence has been associated with advanced progression of the cholesteatoma. There are very few reports for CC available in the medical literature This objective of this review article is to discuss the prevalence, etiopathology, clinical manifestations, diagnosis, and treatment.

IgG4-Related Ureteral Stricture

A 38-year-old female had flank pain that did not relate to menstrual period for 2 months. Renal ultrasound revealed mild hydronephrosis. She had normal CBC, BUN/creatinine was 1.06/15 mg/dL, and microscopic hematuria. CT scan is shown (Fig. 1). The RP and URS revealed 3-cm long bilateral distal ureteral stricture with whitish fibrotic mass, which was biopsied by biopsy forceps (Figs. 2, 3). The pathology report indicated lymphoplasmacytic tissue infiltration with fibrosis. Urine PCR for TB was negative.

First Report of Postharvest Fruit Rot Disease of Yellow Peach Caused by Diaporthe eres in China.

The yellow peach (Amygdalus persica), is a fruit crop native to China with golden peel and pulp that is of particular interest in the fruit markets. In August of 2021, yellow peaches showing fruit rot symptoms were purchased from a commercial market in Linyi city, Shandong province, China. The symptoms included circular, tan to brown in color, rotten, necrotic lesions, and whitish mycelium mass in the center of the lesions. The infected fruit were surface disinfected with 1% NaClO for 30 s and rinsed with sterile distilled water three times. Diseased tissues from the infected fruits were cut into small segments, aseptically shifted onto potato dextrose agar media containing petri plates and incubated at 25℃ for 5 days. Eight isolates were obtained in total from two isolation experiments. Fungal colonies were initially white, aerial, fluffy at first, and gradually turned brown to gray, with black stromata at maturity. Alpha conidia were aseptate，hyaline，fusiform to ellipsoidal，and ranged in size from 4.16 to 7.76 µm × 1.95 to 3.14 µm (n=30). Beta conidia were aseptate, hyaline, filiform, curved to hamate, and 15.91 to 22.55 µm × 0.82 to 1.66 µm (n=30). The morphological characteristics were consistent with those of Diaporthe species (Gomes et al. 2013). For further identification, a multigene phylogenetic analysis was carried out. The internal transcribed spacer (ITS) region, translation elongation factor 1-α (TEF1-α), histone H3 (HIS), calmodulin (CAL), and β-tubulin (TUB) genes of two representative isolates were amplified by using primers ITS1/ITS4, EF1-728F/EF1-986R, CYLH3F/H3-1b，CAL228F/CAL737R, and Bt2a/Bt2b (Chaisiri et al. 2021), respectively. The sequences were deposited in GenBank (Accession No. OL375154 for ITS; OL406409 for TEF1-α; OL406410 for HIS; OL106407 for CAL; OL406408 for TUB). phylogenetic analyses were conducted using the concatenation of multiple sequences (ITS, TEF1-α, HIS, CAL, TUB) with Maximum Likelihood (ML) in IQtree v1.5.6 (Nguyen et al. 2015). Based on the morphological and phylogenetic characters, the isolates were identified as D. eres. A Pathogenicity test was performed by wound inoculation on harvested fruits of A. persica Variety 'Jinxiu'. Mature and healthy yellow peaches purchased from Shandong, Anhui, and Hunan Provinces in China were surface sterilized with 1% NaClO solution for 1 minute, rinsed with sterile water and dried. Each fruit was wounded with a sterile scalpel creating a 2-3 mm incision on the peel. A 5 mm agar disc with mycelium grown on PDA at 28℃ for 7 days was placed on wound and sealed with parafilm. Sterile PDA plugs were used as controls. Ten fruit were used for each treatment and the assays were repeated three times. Inoculated fruit were placed in sterilized transparent plastic cans containing wet, sterile paper towels. After 5 days of incubation at 25℃, the same rot symptoms were observed on fruits inoculated with mycelium and the control remained symptomless. D. eres was re-isolated from the lesions of inoculated fruits and the pathogen identification was confirmed by molecular analysis, thus fulfilling complete Koch's postulates. Although D. eres was previously reported on peach trees of causing shoot blight (Thomidis and Michailides 2009) and stem canker (Prencipe et al. 2017). To our knowledge, this is the first report of D. eres causing postharvest fruit rot of yellow peach in China and it may lead to considerable economic losses in the peach industry should post-harvest disease management practices not be implemented.