scholarly journals A rare association of tonsillar tuberculosis and lichen scrofulosorum

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Anshika Harit ◽  
Anjan Kumar Sahoo ◽  
Ishwar Singh
Keyword(s):  
Sore Throat ◽  
Extrapulmonary Tuberculosis ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Skin Lesions ◽  
Epithelioid Cell ◽  
Body Sensation ◽  
Biopsy Report ◽  
History Of ◽  
Systemic Examination

Abstract Background Both tonsillar tuberculosis and lichen scrofulosorum are sporadic presentations of extrapulmonary tuberculosis. Lichen scrofulosorum commonly presents in children and young adults as lichenoid eruptions over the skin. Granulomatous inflammation of the tonsils, however, presents as non-specific sore throat and foreign body sensation in the throat. The concomitant presentation of the abovementioned tubercular manifestations has not been reported in the literature. Case presentation Herein, we report a case of an 11-year-old male patient who presented with a history of recurrent sore throat and ulcerative lesion over the tonsil. Systemic examination revealed multiple perifollicular eruptions over the trunk and back. The diagnosis was confirmed on histopathological findings of epithelioid cell granulomas with Langerhans giant cells following biopsy from the tonsil and skin lesions. Antitubercular therapy was initiated soon after. The patient responded to treatment as early as 6 weeks and was completely asymptomatic at 1 year of follow-up. Conclusion A diagnosis of granulomatous tonsillitis should alert the physician to the possibility of underlying systemic tuberculosis. In our case, coexistence of lichen scrofulosorum helped us to substantiate the diagnosis based on the biopsy report. Response to antitubercular agents is excellent and should be started at the earliest.

scholarly journals Hepatocellular carcinoma with regional lymphadenopathy caused by sarcoid-like reaction: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tomoko Mizota ◽  
Masato Suzuoki ◽  
Saya Kaku ◽  
Kenichi Mizunuma ◽  
Kazuto Ohtaka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Epithelioid Cell ◽  
Imaging Modalities ◽  
Hepatoduodenal Ligament ◽  
Regional Lymph Nodes ◽  
Multiple Imaging

Abstract Background Sarcoid-like reaction (SLR) is a histological pattern of granulomatous inflammation that is clinically differentiated from sarcoidosis. Since SLR is known to occur in several neoplasias and occasionally causes lymphadenopathy and mimics metastatic malignancy, it needs to be considered whether lymphadenopathy is due to metastasis or SLR for the choice of cancer treatment. Few cases of hepatocellular carcinoma (HCC) with SLR have been reported. Here, a case of HCC with lymphadenopathy diagnosed as SLR without metastasis is presented. Case presentation A 69-year-old woman was admitted to our hospital because of upper abdominal pain. She tested positive for hepatitis C virus ribonucleic acid. Imaging modalities showed an 81 × 65-mm-sized tumor with multiple nodules in segment 3 and a 17 × 12-mm-sized tumor in segment 5 with a common HCC enhancement pattern. In addition, a lymph node in the hepatoduodenal ligament was enlarged at 13 mm in size, suggesting the metastasis of HCC. Hepatectomy of the lateral segment and segment 5 and lymph node dissection in the hepatoduodenal ligament were performed. Both tumors in segments 3 and 5 were pathologically diagnosed as HCC without vessel invasion. The tumors contained necrotic cells and epithelioid cell granulomas with multinucleated giant cells, which is typically observed in sarcoidosis. The dissected lymph nodes also contained epithelioid cell granulomas, as well as giant cells with asteroid bodies. There was no malignancy in the lymph nodes. The pathological findings suggested the coexistence of malignancy and sarcoidosis. However, since the patient did not show any typical findings of pulmonary or cardiac sarcoidosis, the case was diagnosed as HCC with SLR in the primary lesion and regional lymph nodes. Conclusions SLR needs to be considered in the differential diagnosis when a cancer patient develops lymphadenopathy. However, lymphadenopathy due to SLR is indistinguishable from that due to metastasis even when using multiple imaging modalities. Pathological examinations may be helpful for the diagnosis.

scholarly journals A Role for CD154, the CD40 Ligand, in Granulomatous Inflammation

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Julien Villeneuve ◽  
Alexis Desmoulière ◽  
Antoine Dewitte ◽  
Nelly Bordeau ◽  
Pierre Costet ◽  
...  
Keyword(s):  
Carbon Tetrachloride ◽  
Granulomatous Inflammation ◽  
Cd40 Ligand ◽  
Giant Cells ◽  
Absorbable Suture ◽  
Epithelioid Cells ◽  
History Of ◽  
Toxic Liver Injury ◽  
Deficient Mice

Granulomatous inflammation is a distinctive form of chronic inflammation in which predominant cells include macrophages, epithelioid cells, and multinucleated giant cells. Mechanisms regulating granulomatous inflammation remain ill-understood. CD154, the ligand of CD40, is a key mediator of inflammation. CD154 confers a proinflammatory phenotype to macrophages and controls several macrophagic functions. Here, we studied the contribution of CD154 in a mouse model of toxic liver injury with carbon tetrachloride and a model of absorbable suture graft. In both models, granulomas are triggered in response to endogenous persistent liver calcified necrotic lesions or by grafted sutures. CD154-deficient mice showed delayed clearance of carbon tetrachloride-induced liver calcified necrotic lesions and impaired progression of suture-induced granuloma. In vitro, CD154 stimulated phagocytosis of opsonized erythrocytes by macrophages, suggesting a potential mechanism for the altered granulomatous inflammation in CD154KO mice. These results suggest that CD154 may contribute to the natural history of granulomatous inflammation.

scholarly journals Granulomatous Mastitis: Unusual Presentation and Management, Experience at Birdem General Hospital

2018 ◽  
Vol 30 (2) ◽  
pp. 78-80
Author(s):  
Tamanna Narmeen ◽  
MM Masud Pervez
Keyword(s):  
General Hospital ◽  
Extrapulmonary Tuberculosis ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Abscess Formation ◽  
Reproductive Age ◽  
Unusual Presentation ◽  
Pathological Examination ◽  
Study Group ◽  
Age Group

Tuberculosis of breast is an unusual presentation of extrapulmonary tuberculosis. It occurs mostly in women who are of reproductive age group, multiparous and lactating. Common presentation is tumor like but patients of our study group mostly presented with abscess and mastitis. This study was carried out at BIRDEM GENERAL HOSPITAL, ShegunBagicha, Dhaka. Retrospective data of 9 patients with breast tuberculosis was analyzed. Information about demographic details, clinical presentation, cytology, histopathology, comorbidity and management was taken into account. Out of 1202 patients who presented with breast problem during the study period only 9 (0.75%) suffered from tuberculosis of breast. Their age ranged from 20 to 55 years. All patients except 2 presented with abscess formation, 1 with lump and 1 with multiple sinuses. All patients were subjected to histopathology. Their pathological examination showed chronic granulomatous inflammation with caseous necrosis and langerhans giant cells suggestive of tuberculosis. All 9 patients were treated with Anti TB drug therapy after adequate surgical intervention when required. The rare entity tubercular mastitis is a disease of relatively younger age group. Though the usual presentation is tumor like, the patients of the study group mainly presented with abscess formation. Diabetes might be a contributing factor for the unusual presentation among the patients of my study group.Medicine Today 2018 Vol.30(2): 78-80

scholarly journals Blastomycosis Presenting as Multiple Splenic Abscesses: Case Report and Review of the Literature

2010 ◽  
Vol 21 (1) ◽  
pp. 53-56 ◽  
Author(s):  
Sami Al-Nassar ◽  
Tracy MacNair ◽  
Jeremy Lipschitz ◽  
Howard Greenberg ◽  
Elly Trepman ◽  
...  
Keyword(s):  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Silver Stain ◽  
Rare Presentation ◽  
Computed Tomographic ◽  
Northwestern Ontario ◽  
Abdominal Symptoms ◽  
History Of ◽  
Oral Itraconazole ◽  
Methenamine Silver Stain

A 31-year-old Canadian Aboriginal man from northwestern Ontario presented with left upper quadrant pain and a tender left upper quadrant mass. Evaluation with a computed tomography scan showed multiple lesions within the spleen, a collection between the splenic tip and splenic flexure of the colon, and several small adrenal lesions. Computed tomographic-guided needle biopsy showed necrotizing granulomatous inflammation and multinucleated giant cells. Gomori’s methenamine silver stain showed broad-based budding yeast consistent withBlastomyces dermatitidis. Abdominal symptoms resolved after two months of oral itraconazole. Multiple splenic abscesses are a rare presentation of blastomycosis and should be considered in the differential diagnosis of left upper quadrant abdominal pain in a patient with a history of travel or residence in a region endemic forB dermatitidis.

scholarly journals Abdominal Tuberculosis: A Histopathological Study with Special Reference to Intestinal Perforation and Mesenteric Vasculopathy

2009 ◽  
Vol 1 (02) ◽  
pp. 056-061 ◽  
Author(s):  
Alakananda Dasgupta ◽  
Navjeevan Singh ◽  
Arati Bhatia
Keyword(s):  
Histopathological Examination ◽  
Intestinal Tuberculosis ◽  
Granulomatous Inflammation ◽  
Abdominal Tuberculosis ◽  
Epithelioid Cell ◽  
Histopathological Study ◽  
Ulcer Formation ◽  
Microscopic Features ◽  
History Of ◽  
One Year

ABSTRACT Background: Along with the increased incidence of pulmonary tuberculosis in parallel with the increase in population in various parts of the world, in recent years, the incidence of abdominal tuberculosis has also increased. The pathogenetic events in intestinal tuberculosis, which culminate in ulcer formation, perforation, and stricture, still have to be identified. Aim: To correlate the gross and microscopic features in intestinal tuberculosis, in particular tuberculous perforation with changes in mesenteric vasculature. Patients and Methods: A one-year prospective study of excised/resected tissues from patients with abdominal tuberculosis requiring surgical intervention was conducted. Tissues from fifty-six patients were included in the study — of which 36 were resected intestinal segments and 20 were intestinal and lymph node biopsies. Hematoxylin and Eosin and Ziehl-Neelsen stains were used for histopathological examination. Results: Tuberculous enteritis was found to be present in 49 of the 56 patients (87.5%) (ileum being the site most commonly affected), while nodal involvement was seen in 39 (69.6%) patients. Perforations were present in 39 out of 49 (79.6%) intestinal tissues; most being solitary and ileum was the commonest site. Typical epithelioid cell granulomas were seen in the intestine and lymph nodes, with caseation being more prevalent in the latter. The mesenteric vasculature was frequently involved by granulomatous inflammation, with intravascular organizing thrombus being present in 30% of the resected specimens with perforation. Acid fast bacilli were demonstrated in the tissue sections of 37.5% of the patients. AFB positivity was higher in caseating granulomas. Conclusion: Involvement of mesenteric vasculature by granulomatous inflammation was commonly associated with the ulcerative type with perforation, suggesting that ischemia caused by vascular thrombosis is responsible for tissue breakdown. This implies that vasculitis plays an important role in the natural history of abdominal tuberculosis.

scholarly journals Spontaneous intracranial hypotension associated with pachymeningeal enhancement in a patient with systemic lupus erythematosus (SLE): an extremely rare presenting feature

2019 ◽  
Vol 12 (2) ◽  
pp. bcr-2018-227780
Author(s):  
Shrivarthan Radhakrishnan ◽  
Deepanjali Surendran ◽  
Deepak Barathi ◽  
Chanaveerappa Bammigatti
Keyword(s):  
Lupus Erythematosus ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Skin Lesions ◽  
Subdural Effusion ◽  
Dramatic Improvement ◽  
Azathioprine Therapy ◽  
History Of ◽  
Systemic Examination ◽  
Bilateral Papilloedema

A 16-years-old girl presented to our institution with history of severe bilateral headache for 5 days associated with vomiting. She also had fever for 2 months without any localising symptoms and skin lesions for 1 month. Examination revealed erythematous rash over bridge of nose and ear lobes, ulcer over hard palate and tenderness of small joints of both hands. Systemic examination was unremarkable except for bilateral papilloedema. Investigations revealed anaemia, leucopenia and elevated erythrocyte sedimentation rate. Cranial imaging revealed diffuse pachymeningeal enhancement with subdural effusion. Lumbar puncture revealed no abnormal findings in cerebrospinal fluid except low opening pressure. Antinuclear antibody was 4+ with anti-Sm antibody positive. She was diagnosed to have spontaneous intracranial hypotension associated with pachymeningeal enhancement secondary to systemic lupus erythematosus. She showed dramatic improvement with steroid and azathioprine therapy. She continues to be asymptomatic after 2 years of follow-up.

Equine Granulomatous Enteritis

1974 ◽  
Vol 11 (6) ◽  
pp. 535-547 ◽  
Author(s):  
R. E. Cimprich
Keyword(s):  
Weight Loss ◽  
Mycobacterium Tuberculosis ◽  
Plasma Cells ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Gut Content ◽  
Epithelioid Cells ◽  
History Of ◽  
Microscopic Change ◽  
Granulomatous Enteritis

The gross abnormalities in the intestines of 10 horses with a history of chronic weight loss varied greatly. The principal microscopic change was granulomatous inflammation characterized by lymphocytes, plasma cells, macrophages, epithelioid cells and giant cells. Mycobacterium tuberculosis, avian type, was isolated from the gut content of one horse, but no cause was found in the others. Horses previously reported to have tuberculosis had lesions similar to those described here. These lesions are also similar to those in Crohn's disease of man.

scholarly journals Clinicopathological Study on TB Lymphadenopathy Case

2021 ◽  
Vol 20 (1) ◽  
pp. 77-80
Author(s):  
Mohammad Mahabubul Alam Chowdhury ◽  
Pran Gopal Datta ◽  
Abu Sahfi Ahmed Amin ◽  
Khondakar Abdullah Al Mahmud ◽  
Kawsar Sultana
Keyword(s):  
Lymph Nodes ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Epithelioid Cell ◽  
Low Grade ◽  
Care Hospital ◽  
Caseating Granuloma ◽  
Supraclavicular Lymph Nodes ◽  
History Of

Background: Tuberculosis in the form of pulmonary and extrapulmonary TB is common in developing countries like Bangladesh. Among extrapulmonary TB, lymphnode TB is still common in our setting. So, the objectives of the present study were to evaluate theclinicopathological findings among the lymphnode TB cases in our context. Materials and methods: This observational study was done from January 2017 to December 2019 among 300 lymphnode TB cases in a tertiary care hospital during a three-year study period. Patients were selected after obtaining informed written consent and clinical evaluation. Then enlarged lymphnodes were evaluated by FNAC or histopathology. If lymphnode TB features were found then the patients were included in our study.Other findings like metastasis, lymphoma or pyogenic lymphadenitis were excluded from this study. After collection, data was recorded and analyzed by Microsoft Excel. Results: Among 300 cases of TB lymphadenitis subjects were commonly within the age groups 11-20 years (Male 63 and female 51) and 21-30 years(male 45 and female 42) with amale: female ratioof 1.22:1. Regarding different clinical signs and symptoms,low grade fever was found in 21(7%) cases, local lymphnode pain and tenderness was found in 67 (22%) and 63(21%) of subjects. Discharging sinuses was present in 33(11%) patients, 35(12%) had history of weight loss, 39 (13%) had anorexia and 42(14%) had history of night sweats. Regarding locationof different lymph node areas, 125(41.67%) patients had deep cervical nodes, 65(21.67%) had supraclavicular lymph nodes, 60(20%) had lymph nodes in the posterior triangle 33 (11%) in jugulo-omohyoid and 17 (5.66%) in submandibular area. Among all cases, 83% cases showed bilateral and 17% showed unilateral involvement.Regarding nature of lymph nodes, firm, matted multiple lymphnodes were found in 130(43%) cases, single discrete nodes were found in 70(23.33%) cases, others were found as suppurative noded with single and multiple sinuses. Cytopathological and histopathological findings revealed caseating granuloma with epithelioid cell with Langerhans type giant cell was found in 220(73%) cases, caseating granuloma with epithelioid cell was found in 47(16%) epithelioid cell was found in 20(7%) cases and epitheliod cells with smear positive AFB was found in 13(4%) cases. Conclusion: TB lymphadenitis is still a common form of extrapulmonary tuberculosis and it has variable clinical and pathological presentations. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 77-80

scholarly journals The Value of Imaging Methods in the Diagnosis of the Renal Cell Carcinoma Combined with Renal Tuberculosis – Case Report

2013 ◽  
Vol 1 (1) ◽  
pp. 90-92
Author(s):  
Tania Tsocheva ◽  
Regina Djerassi ◽  
Aleksandrina Vlahova ◽  
Mila Liubomirova ◽  
Boris Bogov
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Histological Examination ◽  
Renal Cell ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Epithelioid Cell ◽  
Tuberculosis Case ◽  
Imaging Methods ◽  
Caseous Necrosis

We describe a case of renal cell carcinoma which causes difficulties to set diagnosis with imaging methods. The histological examination revealed renal cell carcinoma associated with epithelioid cell granuloma with caseous necrosis. Granulomatous inflammation is characterized by the accumulation of epithelioid histiocytes and multinucleated giant cells. The cause of granuloma formation can be infectious or non-infectious. Granulomatous response in renal cell carcinoma is rare. This case shows that for accurate diagnosis for suspected tumor is necessary to be used combination of complex imaging - triplex ultrasound, CEUS, CT and histological examination.

scholarly journals Necrobiotic Xanthogranuloma in a Patient with Multiple Myeloma

2016 ◽  
Vol 8 (3) ◽  
pp. 350-353 ◽  
Author(s):  
Marlies Wruhs ◽  
Robert Feldmann ◽  
Isabelle Sawetz ◽  
Friedrich Breier ◽  
Andreas Steiner
Keyword(s):  
Multiple Myeloma ◽  
Clinical Laboratory ◽  
Subcutaneous Fat ◽  
Bone Marrow Aspiration ◽  
Giant Cells ◽  
Skin Lesions ◽  
Complete Disappearance ◽  
Bortezomib Treatment ◽  
Systemic Corticosteroids ◽  
History Of

An 82-year-old woman presented with a 9-month history of multiple, well-defined skin lesions on her neck and upper chest, progressively increasing in size. Histological examination of a skin biopsy showed a regular epidermis. In the dermis, granulomatous changes with central necrobiosis were found which extended focally into the subcutaneous fat. The necrobiotic areas were surrounded by Touton cells and foreign-body giant cells. Laboratory analysis revealed leucopenia. Serum electrophoresis and immunofixation disclosed the presence of an IgG-λ paraprotein. Bone marrow aspiration cytology showed 20% plasmatic cells. The skeletal X-ray revealed frontal and occipital osteolytic skull lesions as well as pubic osteolysis. Urinalysis was unremarkable without proteinuria. Based on the clinical, laboratory, and histological findings, necrobiotic xanthogranuloma in association with multiple myeloma was diagnosed. The patient was treated with bortezomib combined with oral dexamethasone. Follow-up at week 13 revealed the complete disappearance of the IgG paraproteinemia. However, the skin lesions remained unchanged. Therefore, bortezomib treatment was discontinued, and systemic corticosteroids were continued at a higher dosage. After the steroid treatment, the lesions markedly flattened.

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