Clinicopathological study of blue nevi of the gastrointestinal (GI) tract: first case series

2020 ◽  
pp. jclinpath-2020-206757
Author(s):  
Naziheh Assarzadegan ◽  
Kevan Salimian ◽  
Danielle Hutchings ◽  
Annika Lisbeth Windon ◽  
Lysandra Voltaggio ◽  
...  
Keyword(s):  
Case Series ◽  
Clinical Information ◽  
Endoscopic Examination ◽  
Gi Tract ◽  
Pigmented Lesions ◽  
First Case ◽  
Clinicopathological Findings ◽  
Pathology Reports ◽  
Middle Aged Adults

AimBlue nevus (BN) is a benign melanocytic proliferation that is typically cutaneous. Extracutaneous BN is infrequent and is reported in the mucosa of various organs. Gastrointestinal (GI) tract BN is rare. Here, we describe the clinicopathological findings of the largest series of GI tract BNs.MethodsA search of our Pathology Data System (1984–2019) identified six GI tract blue nevi. Clinical information, pathology reports and available H&E-stained section slides were reviewed.ResultsLesions predominated in the middle-aged adults (mean 54, range 27–80) with a slight female predominance (66%). Most cases arose in the rectum and colon (83%), with one gastric lesion (17%). Four cases were identified during endoscopic examination performed either for screening or for unrelated symptoms (66%). Two patients presented with rectal bleeding (33%) unassociated with the BN. Endoscopically, most lesions appeared as superficial hyperpigmented areas (83%). One case was described as abnormal mucosa (17%). Microscopically, the mucosa was involved in all of the cases (100%). One case showed submucosal extension in addition to the mucosal component (17%). Lesions showed a proliferation of bland spindle cells with abundant granular pigment. No nuclear atypia or mitoses were identified. Immunostains showed immunoreactivity for melanocytic markers. Follow-up information available for five patients showed no recurrences to date (mean follow-up 1 year).ConclusionsBN is a benign melanocytic proliferation. It is important to be aware of the occurrence of such lesions outside of the skin and consider the possibility of BN when pigmented lesions are encountered in the GI tract.

scholarly journals Investigation of SARS-CoV-2 RNA in Milk Produced by Women with COVID-19 and Follow-Up of Their Infants: A Preliminary Study

2021 ◽  
Author(s):  
TALAT KILIC ◽  
Sebnem Kilic ◽  
Nurcan Kirici Berber ◽  
Ayten Gunduz ◽  
Yasemin Ersoy
Keyword(s):  
Human Milk ◽  
Prospective Observational Study ◽  
Throat Swab ◽  
Case Series ◽  
The Other ◽  
Breastfed Infants ◽  
Milk Samples ◽  
First Case ◽  
Preliminary Study

Objectives: Studies have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily transmitted from person to person via airborne droplets. It is unclear whether it can be shed into human milk and transmitted to a child via breastfeeding.We investigated the presence of SARS-CoV-2 RNA in human milk samples of 15 mothers with coronavirus disease 19(COVID-19) and in the throat swab samples of their infants. Methods: This is a prospective observational study in which breast milk samples were collected from 15 mothers with COVID-19. The presence of SARS-CoV-2 RNA in the whole human milk samples of the patients was investigated using RT-qPCR. All of the infants underwent a clinical follow-up during their 14-day isolation and their throat swab samples were tested for SARS-CoV-2 RNA. Results: Of 15 mothers with COVID-19, SARS-CoV-2 RNA was detected in milk samples from 4 mothers. The throat swab samples from these mothers’ infants were found to be positive for SARS-CoV-2 RNA. Three of the four mothers were breastfeeding. In addition, during the 14-day isolation, all but three of the mothers breastfed their infants. Of the 12 breastfed infants, while the test for SARS-CoV-2 RNA in throat swab samples was negative in six of the infants, the other six infants, who had mild COVID-19 symptoms, tested positive for SARS-CoV-2 RNA.Clinical outcomes of all mothers and infants were uneventful. Conclusion: To our knowledge, this is the first case series with the largest number of cases with SARS-CoV-2 RNA positivity in human milk samples of mothers with COVID-19. However, we believe that the benefits of breastfeeding may outweigh the risk of SARS-CoV-2 infection in infants

scholarly journals P1693LONG-TERM OUTCOME OF KIDNEY TRANSPLANTATION IN PLASMA CELLS DYSCRASIAS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Fulvia Zappulo ◽  
Gabriele Donati ◽  
Giorgia Comai ◽  
Claudia Bini ◽  
Andrea Angeletti ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Light Chain ◽  
Graft Failure ◽  
Case Series ◽  
University Hospital ◽  
High Dose ◽  
Light Chain Deposition Disease ◽  
Light Chain Amyloidosis ◽  
First Case

Abstract Background and Aims Survival of patients with Multiple Myeloma (MM), Light Chain Amyloidosis (LCA) and Monoclonal Gammopathies of renal significance (MGRS) on chronic renal replacement therapy (RRT) is poor. The gold standand treatment of plasma cell dyscrasias (PCD) is high-dose chemotherapy followed by Autologous Stem Cell Transplantation (ASCT) which can induce complete remission and longer survival than chemotherapy alone. Kidney transplantation (KT) after ASCT could represent an option for patients with PCD and End Stage Renal Disease (ESRD). There is no evidence about the time of follow up required from MM remission and KT. Method We present a case series of 5 patients who underwent KT after ASCT and remission of MM among 2,500 transplant recipients followed at the Nephrology Dialysis and Renal Transplantation Unit of S.Orsola University Hospital from 1967 untill now. As in case of recovery from solid cancers, the feasibility of KT after MM was considered when no signs of relapse were assessed. In our cohort 3 patients were affected by Light Chain Deposition Disease (LCDD), 1 patient presented Myeloma Cast Nephropathy (MCN) and one patient Light Chain Amyloidosis (LCA). They all required RRT and underwent KT after ASCT. Results Time between ASCT and KT ranged from 3 and 11 years and clinical outcome was very different. The mean follow up period ranged from 2 to 4 years. In the first case (LCDD) KT was performed 11 years after ASCT, the graft failure occurred 6 years later because of chronic allograft nephropathy requiring RRT. In the second case (LCDD) patient received KT 3 years after ASCT. He developed Bence-Jones proteinuria requiring specific therapy with Dexametasone and Bortezomib determining progressive graft failure. In the third case (LCDD) KT was performed 4 years after ASCT and the 4 year follow up is negative for relapse of MM or ESRD. The fourth patient presented MCN and received KT 8 years after ASCT. MCN relapsed 6 years later; it caused ESRD requiring RRT. In the last patient (LCA) KT was performed 4 years after ASCT. No recurrence occurred in a 2-year follow up. Conclusion MM is the most frequent malignancy in dialytic population; the need for KT in MM remains high. ASCT improves the quality of life and offers higher survival in patients with myeloma/MGRS/amyloidosis-related ESRD. Therefore the combination of chemotherapy/ASCT and KT is pivotal to pursue renal restoring. Since high risk of recurrence larger study are required to clarify the better follow up period after MM remission and KT.

scholarly journals Updates from China: clinical and research experience of homeopathy in the pandemic

2021 ◽  
Vol 20 (1) ◽  
pp. 08-08
Author(s):  
Ka Lun Aaron To ◽  
Yuen Ying Yvonne Fok
Keyword(s):  
Hong Kong ◽  
Symptomatic Relief ◽  
Case Series ◽  
Clinical Information ◽  
Research Experience ◽  
Prospective Longitudinal Study ◽  
First Case ◽  
Study Results ◽  
Prospective Longitudinal ◽  
Gelsemium Sempervirens

Background: Hong Kong is one of the regions which is most affected by the COVID-19 pandemic in China. In homeopathy, common pathognomonic symptoms are less informative, while homeopathic symptoms are always more helpful for homeopathic prescriptions. Aims: The first case series from Hong Kong was presented and the homeopathic repertorization symptoms observed in the 18 confirmed/suspected cases of COVID-19 in Hong Kong in early 2020 was reported. Methodology: A standard questionnaire on common homeopathic symptoms was filled in by all diagnosed/suspected COVID-19 patients, with or without the help of a consulting-room assistant, before the consultation. Repertorization symptoms from the case series were reported from 18 consecutive patients who used homeopathy as an adjunctive measure, in addition to the conventional or traditional chinese medicine, for symptomatic relief from COVID-19. Anonymized clinical information for research and academic purposes was used and approved by patients. The authors focused mainly on the homeopathic symptoms, i.e. the more individualised and characteristic symptoms which were available in the homeopathic repertories. In the presentation, the demographics, prevelance of homeopathic medicines, common repertorization symptoms in each of the top-ranked remedies, and differentiating symptoms for each top-ranked remedy were presented. Differentiating features were defined as homeopathic symptoms that were present in at least 50% of cases for the top-ranked remedy and in no more than 2 cases for other top-ranked remedies. The data collection project was further extended under the Clificol COVID-19 Support Project, a multinational, combined retrospective, and prospective longitudinal study. Results and discussion: Homeopathic symptoms of 18 cases were presented. All of the cases were categorized as mild. Eighteen common symptoms screened out of 79 selected repertorization symptoms constituted two sets of homeopathic symptom pictures: Bryonia alba (n = 4) and Gelsemium sempervirens (n = 12). Eight and seven differentiating features, respectively, were identified for Bryonia alba and Gelsemium sempervirens. Most updated data from the ongoing COVID-19 Support project was also presented. Conclusion: The common symptoms of 18 mild COVID-19 cases constituted two sets of homeopathic symptom pictures, indicating Bryonia alba or Gelsemium sempervirens; they were indicated in 4 and 12 cases, respectively, out of the 18 in total.

scholarly journals Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a silicone-covered nitinol short bilaterally flared stent: a case series

2017 ◽  
Vol 05 (11) ◽  
pp. E1111-E1116 ◽  
Author(s):  
Raffaele Manta ◽  
Claudio Zulli ◽  
Angelo Zullo ◽  
Edoardo Forti ◽  
Alberto Tringali ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Symptom Relief ◽  
Case Series ◽  
Metal Stents ◽  
Success Rates ◽  
Gallbladder Drainage ◽  
First Case

Abstract Background and study aim Gallbladder drainage in patients with cholecystitis who are unsuitable for surgery may be performed by endoscopic ultrasound (EUS)-guided placement of specifically designed fully covered metal stents. We describe the first case series of patients treated with a silicone-covered nitinol stent with bilateral anchor flanges. Patients and methods Data from consecutive patients with acute cholecystitis who were deemed unsuitable candidates for surgery were collected. The stent placement procedure was performed in two tertiary endoscopy centers by four experienced endoscopists. Technical and clinical success rates, as well as adverse events and clinical outcome at follow-up, were assessed. Results EUS-guided drainage for cholecystitis was performed in 16 patients (mean age 84 years; nine males). Technical and clinical success rates were 100 % (16/16) and 94 % (15/16), respectively; an early failure due to stone impaction occurred in the remaining case and required placement of a new stent. Symptom relief occurred in 11/15 cases (73 %) within 1 day, and within 2 days in the remaining 4 patients. Bleeding occurred in two patients (13 %): in one patient intraprocedural bleeding was successfully stopped during endoscopy; and delayed bleeding occurred in one patient requiring arterial embolization for catastrophic bleeding (patient died 10 days later). No cases of cholecystitis recurrence or biliary obstruction were observed during a median follow-up of 112 days (range 49 – 180 days). Conclusions Our data showed that EUS-guided gallbladder drainage with a specially designed stent is feasible and successful in patients with acute cholecystitis who are unfit for surgery.

scholarly journals Pediatric Extraspinal Sacrococcygeal Ependymoma: Report of Two Cases and Literature Review

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1680
Author(s):  
Francesco Fabozzi ◽  
Silvia Ceccanti ◽  
Antonella Cacchione ◽  
Giovanna Stefania Colafati ◽  
Andrea Carai ◽  
...  
Keyword(s):  
Literature Review ◽  
Case Reports ◽  
Case Series ◽  
Surgical Excision ◽  
Central Canal ◽  
Ependymal Cells ◽  
The Past ◽  
First Case ◽  
One Year

Primary central nervous system (CNS) tumors represent the most common solid tumors in childhood. Ependymomas arise from ependymal cells lining the wall of ventricles or central canal of spinal cord and their occurrence outside the CNS is extremely rare, published in the literature as case reports or small case series. We present two cases of extra-CNS myxopapillary ependymomas treated at our institution in the past three years; both cases originate in the sacrococcygeal region and were initially misdiagnosed as epidermoid cyst and germ cell tumor, respectively. The first case, which arose in a 9-year-old girl, was treated with a surgical excision in two stages, due to the non-radical manner of the first operation; no recurrence was observed after two years of follow-up. The other case was a 12-year-old boy who was treated with a complete resection and showed no evidence of recurrence at one-year follow-up. In this paper, we report our experience in treating an extremely rare disease that lacks a standardized approach to diagnosis, treatment and follow-up; in addition, we perform a literature review of the past 35 years.

scholarly journals The SARS-CoV-2 RNA with mild lung lesions lasts longer in non-severe COVID-19 patients: a case series study

2020 ◽  
Author(s):  
Chi Zhang ◽  
Jiawen Li ◽  
Jing Mu ◽  
Daitao Zhang ◽  
He Wang ◽  
...  
Keyword(s):  
Lung Injury ◽  
Case Series ◽  
Clinical Information ◽  
Igg Antibody ◽  
Global Pandemic ◽  
Case Series Study ◽  
Group A ◽  
Group B ◽  
Almost All

Abstract Background COVID-19 has become a new infectious disease in the global pandemic, most of which are non-severe patients. It is particularly important to understand the dynamic changes of the whole disease course of non-severe patients from the onset to the follow-up after discharge.Methods On February 1, 2020, 18 cases of non-severe COVID-19 appeared in a hospital in Beijing. We recorded the clinical information and viral dynamics of these patients from the onset of the disease to one month after discharge.Results Eighteen patients (median age 43) were included, including 14 females. Fever (11/18) and cough (8/18) are the most common symptoms. According to the degree of lung inflammation, 18 patients were divided into two groups (group A imaging score ≤ 10; group B imaging score > 10). The duration of SARS-CoV-2 positive in group A was significantly longer than that in group B (the median was 30 and 13, respectively, P = 0.0025). One month after discharge, almost all patients were followed up for IgM antibody disappearance and IgG antibody production.Conclusion In non-severe COVID-19 patients, the positive duration of the SARS-CoV-2 in patients with mild lung injury was longer than that in patients with severe lung injury. The possible mechanism is that the virus-mediated immune system is not fully activated in mild damaged patients.

Thrombocytopenia associated with ipilimumab therapy of advanced melanoma at a single institution.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9072-9072 ◽  
Author(s):  
Monique Z. Sajjad ◽  
Timothy George ◽  
Jeffrey S. Weber ◽  
Lubomir Sokol
Keyword(s):  
Cytotoxic T Lymphocyte ◽  
Case Series ◽  
Complete Response ◽  
Median Number ◽  
Hematologic Toxicity ◽  
Vascular Events ◽  
Normal Platelet ◽  
First Case ◽  
Pathology Reports ◽  
Steroid Refractory

9072 Background: Ipilimumab (IPi) is a monoclonal IgG1κ antibody targeting cytotoxic T-lymphocyte antigen-4 (CTLA-4) that was approved for the treatment of metastatic melanoma (MM). IPi therapy is associated with immune-related adverse events (irAEs) (Weber et al. J Clin Oncol2012 Jul 20;30(21):2691-7). Hematologic toxicity has rarely been reported. Methods: We analyzed 172 pts with MM treated adjuvantly or for metastatic disease with IPi on 2 clinical studies and an expanded access program (protocols MCC15283, MCC15722 and MCC15977). Clinical characteristics and hematologic parameters related to therapy were recorded. Medications, infections, comorbidities, prior therapies, and pathology reports from bone marrow (BM) biopsies were reviewed. Results: Of 172 subjects, 10 (5.8%) pts with normal platelet counts prior to therapy, developed thrombocytopenia (TCP) following IPi. Median number of doses was 8.5 (range 1-19). Median age at development of TCP was 64 years (range 21-93). Median time to development of TCP was 16.5 months (range 0.25 – 39). Of ten pts, three developed grade (gr) 1 or 2 TCP, three developed gr 3 and four pts developed gr 4 thrombocytopenia. BM analysis in pts with gr 4 TCP showed normal hematopoiesis and no evidence of melanoma. Six of 10 (60%) pts required therapy and were initiated on prednisone, but were deemed steroid refractory. No sustained responses to subsequent treatments with IVIG, rituximab, danazol, and/or splenectomy were observed. Three pts with grade 4 TCP were treated with eltrombopag. One of them achieved a sustained complete response lasting > 20 months. The other 2 pts who received eltrombopag discontinued treatment due to vascular events. Three out of 10 (30%) pts with any gr of TCP experienced mild bleeding episodes in the form of epistaxis. One pt with gr 4 thrombocytopenia experienced severe gastrointestinal bleeding requiring hospitalization. No deaths related to bleeding occurred. Conclusions: This is the first case series of hematologic irAEs in pts treated with IPi on clinical trials, suggesting that steroid refractory TCP may occur with IPi treatment . The timing and severity of IPi associated TCP is highly variable so careful hematologic monitoring should be considered.

scholarly journals Endoscopic features of gastrointestinal tuberculosis and crohn’s disease

2017 ◽  
Vol 08 (01) ◽  
pp. 01-11
Author(s):  
Praneeth Moka ◽  
Vineet Ahuja ◽  
Govind K. Makharia
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Tuberculosis ◽  
Endoscopic Examination ◽  
Gi Tract ◽  
Ileocecal Region ◽  
Histological Features ◽  
Geographical Regions ◽  
Endoscopic Characteristics

AbstractEndoscopic examination of the gastrointestinal (GI) tract plays a very important role in the diagnosis and follow-up of patients with Crohn’s disease (CD) and intestinal tuberculosis (TB). The clinical, morphological, and histological features of GI TB and CD are so similar that it becomes difficult to differentiate between these two entities. In geographical regions such as India where both GI TB and CD are prevalent, differential diagnosis between the two is challenging. While there is a lot of similarities between these two disorders, these two can be differentiated from each other with a combination of clinical, endoscopic, histological, radiological, and endoscopic features. The observation of the characteristic lesions at endoscopic examination and the extent of involvement in CD and intestinal TB is an important step in differentiation between these two disorders. While the most important endoscopic characteristics such as involvement of left side of the colon and presence of longitudinal ulcerations and cobblestoning support a diagnosis of CD, predominant involvement of ileocecal region and transverse ulcers support the diagnosis of intestinal TB. In this review, we have described the usefulness and limitations of endoscopic modalities in the diagnosis and differentiation of intestinal TB and CD.

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