Nerve Involvement in Granuloma Annulare

Background: Nerve involvement developed in a patient with granuloma annulare, as evidenced by a perineural infiltrate of histiocytes in the dermis. The histopathologic pattern was suggestive of leprosy. No mycobacteria were observed, and neurologic testing was normal. Objective: To determine whether inflammation of the nerves or perineural tissue is common in granuloma annulare, we studied the cutaneous nerves in skin biopsy specimens from 14 patients with granuloma annulare. Methods: Sections were stained with hematoxylin-eosin to highlight inflammatory cells and with S-100 to identify cutaneous nerves. Results: No inflammation around nerves was found in 12 specimens, abutting granulomatous inflammation was found in 1 specimen, and enveloping granulomatous inflammation was found in 1 specimen. No nerves were infiltrated by inflammatory cells. Conclusion: Perineural granulomatous inflammation resembling the perineural infiltrate of leprosy appears to be an uncommon characteristic of granuloma annulare. Clinical correlation and acid-fast stains can assist in establishing the correct diagnosis. Contexte: Une atteinte nerveuse est apparue chez un patient atteint de granulome annulaire, comme en témoignait un infiltrat périneural d'histiocytes dans le derme. Les signes histopathologiques étaient évocateurs de la lèpre, mais aucune mycobactérie n'a été observée, et l'examen neurologique était normal. Objectif: L'étude visait à déterminer si l'inflammation des nerfs ou du tissu périneural est fréquente dans le granulome annulaire; pour ce faire, nous avons examiné les nerfs cutanés dans des prélèvements biopsiques de la peau, effectués sur 14 patients atteints de granulome annulaire. Méthodes: Les coupes ont été colorées à l'hématoxyline-éosine pour mettre en évidence des cellules inflammatoires, ainsi qu'au S-100 pour repérer les nerfs cutanés. Résultats: Aucune inflammation autour des nerfs n'a été observée sur 12 prélèvements, mais il y avait présence d'inflammation granulomateuse contiguë sur un prélèvement et d'inflammation granulomateuse enveloppante, sur un autre prélèvement. Les nerfs n'ont pas été infiltrés par les cellules inflammatoires. Conclusion: L'inflammation granulomateuse périneurale qui ressemble à l'infiltration périneurale observée dans la lèpre semble un signe peu fréquent du granulome annulaire. L'établissement de corrélations cliniques et des colorations résistantes à l'acide peuvent faciliter la pose du bon diagnostic.

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"Pseudorheumatoid" Nodules in Children: Report of 10 Cases

PEDIATRICS ◽

10.1542/peds.45.3.473 ◽

1970 ◽

Vol 45 (3) ◽

pp. 473-478 ◽

Cited By ~ 1

Author(s):

John D. Burrington

Keyword(s):

Rheumatoid Arthritis ◽

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Inflammatory Cells ◽

Granuloma Annulare ◽

Subcutaneous Nodules ◽

Rheumatoid Nodules ◽

Clinical Variant ◽

Ulnar Aspect ◽

Palm Of The Hand

Subcutaneous nodules, composed of necrotic collagen surrounded by chronic inflammatory cells, occur in about 20% of individuals with rheumatoid arthritis, 10% of those with acute rheumatic fever, and 25% of children with granuloma annulare. Similar subcutaneous lesions indistinguishable from rheumatoid nodules may appear in children who do not develop other stigmata of disease. Mesara and ous lesions of granuloma annulare. Therefore, they felt that, in children, these nodules probably represented a clinical variant of granuloma annulare. Beatty3 described nine children aged 11 days to 9 years with nodules on the scalp, ulnar aspect of the arm, dorsum of the foot, and palm of the hand which appeared histologically to be rheumatoid nodules.

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Concordance of Bronchoalveolar Lavage Cytology with Transbronchial Lung Biopsies in Non-neoplastic Pulmonary Diseases

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48003.14971 ◽

2021 ◽

Author(s):

Nischita Jayaraj ◽

Kusuma Venkatesh

Keyword(s):

Bronchoalveolar Lavage ◽

Interstitial Pneumonia ◽

Lung Diseases ◽

Correct Diagnosis ◽

Usual Interstitial Pneumonia ◽

Granulomatous Inflammation ◽

Pulmonary Diseases ◽

Differential Count ◽

Flexible Bronchoscope ◽

Cell Counts

Introduction: In many pulmonary diseases, despite radiological & clinical investigations, laboratory tests and function studies, the diagnosis becomes difficult. Bronchoalveolar Lavage (BAL) is a minimally invasive method in which cells are collected from bronchial and alveolar spaces for cytology. This is facilitated by using a flexible bronchoscope with which a biopsy is taken following BAL. Bronchoscopy with BAL when used appropriately can offer correct diagnosis which in turn aids in proper management of the patient. Aim: To find the concordance of BAL findings with the histopathological features of Transbronchial Lung Biopsy (TBLB) in non-neoplastic lung diseases. Materials and Methods: It was a retrospective study conducted in Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka. A total of 40 patients presenting with clinico-radiological findings, suggesting a non-neoplastic lung disease in the year 2019, undergoing bronchoscopy with BAL and concurrent TBLB were chosen. The BAL fluid was processed and differential count of cells was done to classify according to the American Thoracic Society Guidelines. Concordance was checked between the diagnoses made on TBLB and BAL analysis. Results: In the present study, a total of 40 cases were included of which 13 (32.5%) cases showed neutrophilic, 16 (40%) cases showed lymphocytic, 5 (12.5%) cases showed eosinophilic and 6 (15%) cases showed normal cellular distribution on BAL cytology. Diagnoses on studying TBLB included nine cases of Nonspecific Interstitial Pneumonia, seven cases of Usual Interstitial Pneumonia, six cases of Bronchiolitis Obliterans Organising Pneumonia, three cases of Bronchiolitis, two cases each of pulmonary tuberculosis and granulomatous inflammation. There was one case each of actinomycosis, sarcoidosis, lung abscess and mucor mycosis. Normal histology was noted in seven cases. The sensitivity of BAL fluid analysis was found to be 84.84% and the concordance was 80%. The Kappa value obtained was 0.71 indicating good agreement/concordance between BAL cytology and TBLB. Conclusion: The data from the current study suggest that differential cell counts in BAL provide diagnostic information of fundamental importance in frequently occurring non-neoplastic lung diseases in the community.

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A Reliable Surgical Procedure for Sinus Floor Augmentation with Antral Pseudocysts

Dentistry Journal ◽

10.3390/dj9100122 ◽

2021 ◽

Vol 9 (10) ◽

pp. 122

Author(s):

Yasuhiro Nosaka ◽

Hitomi Nosaka ◽

Yasushi Nakajima ◽

Tadasuke Tanioka ◽

Daniele Botticelli ◽

...

Keyword(s):

Soft Tissues ◽

Correct Diagnosis ◽

Inflammatory Cells ◽

Histological Evaluation ◽

Histopathological Diagnosis ◽

Cystic Lesions ◽

Two Stage ◽

Asymptomatic Patients ◽

Sinus Floor Augmentation ◽

Sinus Floor

An antral pseudocyst (AP) is a common well-defined ‘dome-shaped’ faintly radiopaque lesion of the maxillary sinus, and usually does not require treatment in asymptomatic patients. However, when sinus floor augmentation is required to increase bone volume for implant installation, the elevation of the sinus mucosa might drive the AP against the ostium. This might cause its obstruction and, as possible consequence, sinusitis. The purpose of this study was to investigate the clinical and tomographic conditions of APs to identify a predictable cyst removal that might allow a safety sinus floor augmentation. A total of 52 maxillary sinuses in 46 patients (mean age 55.1 years) presenting AP were examined by cone beam computed tomographies (CBCTs). A two-stage approach was applied. At the first surgery, the cystic lesions were further inspected by an endoscope through the antrostomy, and histopathological diagnosis of the removed tissues was carried out. After the confirmation of decrease of the swelling of sinus membrane by CBCT, the sinus floor augmentation was performed, at least four months after cyst removal. The color and transparency of the 86 cystic lesions were classified into 4 types. The whitish transparent cysts were 34 (39.5%), the yellowish transparent cysts were 18 (20.9%), the dark purple transparent cysts were 8 (9.3%) and the milky-white opaque cysts were 26 (30.2%). The contents of the 60 (69.8%) transparent cysts were serous fluid, but those of milky-white cysts were composed of viscous or elastic soft tissues, and the aspiration of the contents was unsuccessful. The analysis of the preoperative CBCT did not provide certainty on the contents of the cystic lesions. All cystic lesions were diagnosed as AP, and an infection was identified in one AP, presenting marked infiltration of the inflammatory cells. Considering the difficulties of performing a correct diagnosis of the AP content by a CBCT analysis, the risk of failure of the surgery that creates severe afflictions to the patients, and the necessity of a histological evaluation of the cyst, a two-stage surgery appeared to be the most reliable procedure.

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Pathomorphological features of clinical forms of ulcerative colitis in children

CHILD`S HEALTH ◽

10.22141/2224-0551.16.1.2021.226445 ◽

2021 ◽

Vol 16 (1) ◽

pp. 1-7

Author(s):

M.F. Denysova ◽

T.D. Zadorozhna ◽

N.Yu. Bukulova ◽

T.М. Archakova

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Process ◽

Unknown Origin ◽

Chronic Inflammatory Disease ◽

Clinical Forms ◽

Biopsy Specimens ◽

Histological Method ◽

Intestine Mucosa ◽

Mucous Barrier ◽

Hematoxylin Eosin

Background. Ulcerative colitis is a chronic inflammatory disease of unknown origin, characterized by a clinically recurrent course with periods of bloody diarrhea and pathomorphological-diffuse inflammatory process in the colon. The problem of ulcerative colitis requires further study of the clinical features of the disease, taking into account the localization, degree of activity of the inflammatory process, changes in the structure of the mucous membrane that will help increase the efficiency of ulcerative colitis diagnosis in childhood. Materials and methods. On the basis of clinical and statistical analysis of 116 case histories of children aged 4–18 years with ulcerative colitis, the features of its clinical forms — total, segmental and distal — were studied during the period of exacerbation of the disease. Four hundred and forty-five biopsy specimens obtained during colonoscopy were histologically examined. After biopsy sampling, specimens were fixed in 10% formalin and were processed according to the generally accepted histological method with section staining using hematoxylin-eosin and according to Van Gieson. Results. Changes in the architectonics of the large intestine mucosa, which reduce the resistance of the mucous barrier, as well as impaired blood supply — a factor in the development of hemic hypoxia — are significant for the mechanisms of ulcerative colitis exacerbation.

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Myofibroma of the Gingiva: Report of a Case

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.34.3.w746852328uxj577 ◽

2010 ◽

Vol 34 (3) ◽

pp. 253-257 ◽

Cited By ~ 5

Author(s):

Banu Özveri Koyuncu ◽

Mert Zeytinoğlu ◽

Taha Ünal ◽

Bülent Zeytinoğlu

Keyword(s):

Benign Tumor ◽

Smooth Muscle Actin ◽

Correct Diagnosis ◽

Benign Neoplasm ◽

Surgical Excision ◽

Solitary Lesion ◽

Immunohistochemical Markers ◽

Mesenchymal Neoplasm ◽

S 100 ◽

Histopathologic Evaluation

Myofibroma is a benign mesenchymal neoplasm composed of myofibroblasts which has been described with different synonyms since the first report in 1951. It occurs most commonly as a solitary lesion of soft tissue,skin, or bone in infancy. The prognosis of oral myofibromas is excellent, and surgical excision is curative. Recurrence is rare. Awareness and recognition of this benign tumor is important to establish the correct diagnosis and avoid morbidity of unnecessary aggressive therapy. This report describes a myofibroma of the gingiva in a 14 year old girl and is reported together with the conventional histologic, and immunohistochemical findings. The tumor showed rapid increase in size and clinical features suggestive of malignancy. However, on histopathologic evaluation it was diagnosed as a benign neoplasm, and this diagnosis was supported by immunohistochemical markers. The spindle cells were immunopositive for smooth muscle actin,and vimentin but were negative for desmin and S-100 protein. The patient was treated with surgical excision,and is followed-up for 33 months without any signs of recurrence.

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Mastocytic Enterocolitis: Increased Mucosal Mast Cells in Chronic Intractable Diarrhea

Archives of Pathology & Laboratory Medicine ◽

10.5858/2006-130-362-meimmc ◽

2006 ◽

Vol 130 (3) ◽

pp. 362-367 ◽

Cited By ~ 13

Author(s):

Shriram Jakate ◽

Mark Demeo ◽

Rohan John ◽

Mary Tobin ◽

Ali Keshavarzian

Keyword(s):

Mast Cell ◽

Mast Cells ◽

High Power ◽

Chronic Diarrhea ◽

Duodenal Biopsy ◽

Mast Cell Tryptase ◽

High Power Field ◽

Intractable Diarrhea ◽

Biopsy Specimens ◽

Hematoxylin Eosin

Abstract Context.—In some adult patients with chronic intractable diarrhea, the diagnosis remains elusive even after detailed evaluations, and colonic or duodenal biopsy specimens may appear unremarkable on routine hematoxylin-eosin staining. Objectives.—To assess the concentration of mast cells in colonic or duodenal biopsy specimens by immunohistochemical analysis for mast cell tryptase from patients with chronic intractable diarrhea and to evaluate their response to drugs affecting mast cell function. Design.—Mast cells per high-power field were assessed in biopsy specimens from 47 patients with chronic intractable diarrhea, from 50 control subjects, and from 63 patients with other specific diseases that cause chronic diarrhea (inflammatory bowel disease, celiac disease, collagenous colitis, and lymphocytic colitis). Patients with chronic intractable diarrhea who had more than 20 mast cells per high-power field were administered drugs affecting mast cell mediator function and release. Results.—The mean ± SD concentration of mast cells in the 50 control subjects was 13.3 ± 3.5 cells per high-power field; hence, patients with more than 20 mast cells per high-power field were considered to have increased mast cells. Thirty-three (70%) of 47 patients with chronic intractable diarrhea had increased mast cells, and symptoms were controlled by drug therapy in 22 (67%) of the 33 patients. No patient had systemic or cutaneous mastocytosis. No increase in mast cells was seen in patients with other common causes of chronic diarrhea. Conclusions.—In chronic intractable diarrhea, colonic or duodenal biopsy specimens may appear unremarkable on routine hematoxylin-eosin staining, but increased mast cells may be demonstrated by immunohistochemistry for mast cell tryptase, with the novel term mastocytic enterocolitis describing this condition. Similar increases in mast cells are not apparent in control populations or in patients with other specific diseases that cause chronic diarrhea. The cause of the increased mast cells remains to be elucidated.

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Use of cholesterol and soluble tumour markers CEA and syndecan-2 in pleural effusions in cases of inconclusive cytology

Journal of Clinical Pathology ◽

10.1136/jclinpath-2018-205650 ◽

2019 ◽

Vol 72 (8) ◽

pp. 529-535

Author(s):

Miklos Gulyas ◽

Janos Fillinger ◽

Andras D Kaposi ◽

Miklos Molnar

Keyword(s):

Correct Diagnosis ◽

Inflammatory Cells ◽

Cholesterol Concentration ◽

Specific Information ◽

Pleural Effusions ◽

Diagnostic Efficacy ◽

Pathological Conditions ◽

Additional Value ◽

Pleural Involvement ◽

Cholesterol Measurement

AimsIn order to improve diagnostics in pleural effusions, additional value of effusion cholesterol, carcinoembryonic antigen (CEA) and syndecan-2 assays to cytology was studied.MethodsBiomarkers were measured in effusion supernatants from 247 patients, of whom 126 had malignant pleural involvement, and their additional diagnostic efficacy to cytology was assessed.ResultsSyndecan-2 measurement, although gave detectable concentrations in all effusions with highest median value in mesotheliomas, was non-discriminative between different pathological conditions. CEA concentrations exceeding 5 ng/mL cut-off point indicated carcinomas, regardless of pleural involvement, which gave a sensitivity of 62% and specificity of 100% for carcinoma. Cholesterol concentration over 1.21 mmol/L cut-off value indicated neoplastic pleural involvement with 99% sensitivity and ‘merely’ 69% specificity, the latter mainly due to raised levels being associated also with benign inflammatory effusions. Combined CEA and cholesterol determinations increased the sensitivity for diagnosing carcinomatosis from 70% with cytology alone to 84% and established the correct diagnosis in 16 of 31 carcinomatosis cases with inconclusive cytology. Cholesterol measurement alone, with elevated level, in combination with absence of substantial number of inflammatory cells in effusion sediment proved to be a magnificent marker for neoplastic pleural involvement with 99% efficacy, and recognised all 36 such cases with inconclusive cytology.ConclusionsSimultaneous measurement of CEA and cholesterol concentrations in effusion, or at least cholesterol alone, in combination with non-inflammatory fluid cytology, provides additional specific information about neoplastic pleural involvement, and can therefore be used as an adjunct to cytology, above all, in inconclusive cases.

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Evaluation of Barrett Esophagus by Multiphoton Microscopy

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0675-oa ◽

2014 ◽

Vol 138 (2) ◽

pp. 204-212 ◽

Cited By ~ 12

Author(s):

Serena Wong ◽

Michael H. Nathanson ◽

Jianxin Chen ◽

Dhanpat Jain

Keyword(s):

Harmonic Generation ◽

Second Harmonic ◽

Gastroesophageal Junction ◽

Multiphoton Microscopy ◽

Goblet Cells ◽

Squamous Mucosa ◽

Biopsy Specimens ◽

Photon Excitation ◽

Gastric Type ◽

Hematoxylin Eosin

Context.—Multiphoton microscopy (MPM) based on 2-photon excitation fluorescence and second-harmonic generation allows simultaneous visualization of cellular details and extracellular matrix components of fresh, unfixed, and unstained tissue. Portable multiphoton microscopes, which could be placed in endoscopy suites, and multiphoton endomicroscopes are in development, but their clinical utility is unknown. Objective.—To examine fresh, unfixed endoscopic biopsies obtained from the distal esophagus and gastroesophageal junction to (1) define the MPM characteristics of normal esophageal squamous mucosa and gastric columnar mucosa, and (2) evaluate whether diagnosis of intestinal metaplasia/Barrett esophagus (BE) could be made reliably with MPM. Design.—The study examined 35 untreated, fresh biopsy specimens from 25 patients who underwent routine upper endoscopy. A Zeiss LSM 710 Duo microscope (Carl Zeiss, Thornwood, New York) coupled to a Spectra-Physics (Mountain View, California) Tsunami Ti:sapphire laser was used to obtain a MPM image within 4 hours of fresh specimen collection. After obtaining MPM images, the biopsy specimens were placed in 10% buffered formalin and submitted for routine histopathologic examination. Then, the MPM images were compared with the findings in the hematoxylin-eosin–stained, formalin-fixed, paraffin-embedded sections. The MPM characteristics of the squamous, gastric-type columnar and intestinal-type columnar epithelium were analyzed. In biopsies with discrepancy between MPM imaging and hematoxylin-eosin–stained sections, the entire tissue block was serially sectioned and reevaluated. A diagnosis of BE was made when endoscopic and histologic criteria were satisfied. Results.—Based on effective 2-photon excitation fluorescence of cellular reduced pyridine nucleotides and flavin adenine dinucleotide and lack of 2-photon excitation fluorescence of mucin and cellular nuclei, MPM could readily identify and distinguish among squamous epithelial cells, goblet cells, gastric foveolar-type mucous cells, and parietal cells in the area of gastroesophageal junction. Based on the cell types identified, the mucosa was defined as squamous, columnar gastric type (cardia/fundic-type), and metaplastic columnar intestinal-type/BE. Various types of mucosa seen in the study of 35 biopsies included normal squamous mucosa only (n = 14; 40%), gastric cardia-type mucosa only (n = 2; 6%), gastric fundic mucosa (n = 6; 17%), and both squamous and gastric mucosa (n = 13; 37%). Intestinal metaplasia was identified by the presence of goblet cells in 10 of 25 cases (40%) leading to a diagnosis of BE on MPM imaging and only in 7 cases (28%) by histopathology. In 3 of 35 biopsies (9%), clear-cut goblet cells were seen by MPM imaging but not by histopathology, even after the entire tissue block was sectioned. Based on effective 2-photon excitation fluorescence of elastin and second-harmonic generation of collagen, connective tissue in the lamina propria and the basement membrane was also visualized with MPM. Conclusions.—Multiphoton microscopy has the ability to accurately distinguish squamous epithelium and different cellular elements of the columnar mucosa obtained from biopsies around the gastroesophageal junction, including goblet cells that are important for the diagnosis of BE. Thus, use of MPM in the endoscopy suite might provide immediate microscopic images during endoscopy, improving screening and surveillance of patients with BE.

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Lung Histopathology of Laying Hens Infected by Colibacillosis in the Animal Cages Experiments of the Disease Investigation Center 6, Denpasar, Bali

Advances in Tropical Biodiversity and Environmental Sciences ◽

10.24843/atbes.2019.v03.i02.p02 ◽

2019 ◽

Vol 3 (2) ◽

pp. 25

Author(s):

Kadek Ayu Trisna Yanti ◽

Iriani Setyawati ◽

Ni Putu Adriani Astiti

Keyword(s):

Laying Hens ◽

Histopathological Examination ◽

Inflammatory Cells ◽

Gallus Gallus Domesticus ◽

Directorate General ◽

Lung Histopathology ◽

Live Stock ◽

Hematoxylin Eosin ◽

Paraffin Method ◽

Neutral Buffer Formalin

This study aimed to determine the lungs histopathology of laying hens (Gallus gallus domesticus) at the Animal Cage Experiments in the Disease Investigation Center 6, Directorate General of Live Stock (DIC-6 DGLS), Denpasar, Bali, which died from colibacillosis infection. Sample of lungs were cut transversely then put into 10% of Neutral Buffer Formalin, then processed histologically by paraffin method and stained with Hematoxylin-Eosin. Observation under microscope (magnification 100x and 400x) was done for histopathological examination. Laying hens died from colibacillosis infection showed that their lungs were infected by colibacillosis, and there were found 62.50% of necrosis, 75% of inflammatory cells infiltration and 80% of hemorrhage in the lungs.

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