scholarly journals The Frequency and Causes of Subepidermal Gaps or Blisters and the Compliance Rate Between Clinical Diagnosis and Pathology Reports from 2015 to 2019

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Abbas Darjani ◽  
Hojat Eftekhari ◽  
Seyedeh Rojin Amini Rad ◽  
Narges Alizadeh ◽  
Rana Rafiee ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Skin Diseases ◽  
Histopathological Examination ◽  
Compliance Rate ◽  
Clinical Manifestations ◽  
Final Diagnosis ◽  
Direct Immunofluorescence ◽  
Diagnostic Challenge ◽  
Cross Sectional ◽  
Pathology Reports

Background: Skin diseases are the fourth most common cause of human illness, and blisters with different clinical manifestations make a diagnostic challenge. Objectives: This study aimed to evaluate the frequency and causes of subepidermal gaps or blisters, as well as the compliance rate between the initial and final clinical diagnoses based on pathology reports. Methods: In this cross-sectional study, pathology reports of subepidermal blisters or gaps were evaluated in the patients referred to the Razi Laboratory of Rasht from 2015 to 2019. The samples were examined by a pathologist after hematoxylin and eosin staining. The reports included demographic information, clinical differential diagnoses, final diagnosis, direct immunofluorescence findings, and salt split results. Finally, the compliance rate of clinical diagnosis with pathology reports was determined. Results: A total of 183 pathology reports were evaluated, 170 of which contained the final diagnosis. Females were more frequently affected by the disease, and pemphigoid bolus and lichen planus were the most prevalent final diagnoses. The compliance rate between the initial and final diagnoses was 94%. About 37.2% of the reports lacked direct immunofluorescence (DIF) and salt split, and only 42.6% of the samples had undergone DIF examination, while 20.2% had both DIF and salt split. There was no significant association between the compliance rate of the final diagnosis with age, sex, and undergoing diagnostic tests. Conclusions: A high incidence of subepidermal gaps or blisters was seen in middle-aged individuals and females. The compliance rate of the initial clinical diagnosis with the final diagnosis based on pathological reports was high. Our findings emphasize the importance of histopathological examination and the complementary role of direct immunofluorescence and salt split in diagnosis.

scholarly journals Clinicopathological Evaluation of Eyelid and Conjunctival Lesions in Patients of Farshchian Hospital in Hamadan

2018 ◽  
Vol 3 (3) ◽  
pp. 120
Author(s):  
Fateme Eslami ◽  
Hamidreza Ghasemibasir
Keyword(s):  
Clinical Diagnosis ◽  
Malignant Tumors ◽  
Histopathological Examination ◽  
Age Groups ◽  
Final Diagnosis ◽  
Histological Diagnosis ◽  
Bulbar Conjunctiva ◽  
Benign Lesions ◽  
Cross Sectional ◽  
Clinical Appearance

Introduction: The lesions of the eyelid and conjunctiva are benign and malignant. The ratio of benign lesions is more than the malignant, increases with age, and are easily diagnosed clinically. However, in some cases, the clinical diagnosis of malignant tumors is impossible, necessitating the final diagnosis by histopathological examination. The incidence of benign and malignant tumors differs between countries according to the genetics of the racial population or environmental factors.Materials and methods: This cross-sectional descriptive study was conducted on 424 patients with eyelid and conjunctival lesions from the Farshchian Hospital of Hamadan between 2010–2014. The final pathological report, clinical diagnosis, demographic variables including age and gender, site of lesions, and clinical appearance were extracted from medical records.Results: The lesions consisted of 159 (37.5%) eyelid and 265 (62.5%) conjunctival lesions. The predominant location was bulbar conjunctiva (35.1%), and the least was external canthus (1.7%). The most frequent lesion based on clinical diagnosis was pterygium (51.7%), and the least frequent was sebaceous glands carcinoma. The most frequent lesion based on histological diagnosis was pterygium (52.5%), and the least frequent was xanthelasma. In this study, the concordance between clinical and histological diagnosis was 90.3% that indicated the physician’s accurate diagnosis.Conclusion: According to this study, the frequency of eyelid and conjunctival lesion was similar in males and females. The prevalence of lesions in >60-year-olds is more common than that in other age groups. The benign lesions of eyelids and conjunctiva are common than malignant lesions. Despite high clinicopathological concordance, the physician should always consider the rare cases, and the pathological diagnosis must be considered for all specimens.

scholarly journals Solitary Schwannoma on the Hypothenar Region of the Hand: A Literature Review

2020 ◽  
Vol 5 (10) ◽  
pp. 449-452
Author(s):  
Kastanis G ◽  
Kapsetakis P ◽  
Magarakis G ◽  
Bachlitzanaki M ◽  
Christoforidis C ◽  
...  
Keyword(s):  
Literature Review ◽  
Clinical Diagnosis ◽  
Peripheral Nerves ◽  
Histopathological Examination ◽  
Final Diagnosis ◽  
Benign Tumors ◽  
Rare Manifestation ◽  
Histopathological Evidence ◽  
Volar Surface

Schwannomas or neurilemmomas are the most common benign tumors of the neural sheaths of the peripheral nerves. Incidence of these tumors in the hand accounts to 0.8-2%. The majority of them appear as an isolated grown mass along the route of the nerves. Peripheral nerves benign tumors present many difficulties concerning the clinical diagnosis and only histopathological evidence provides the final diagnosis. In this case study, we present a 45 year old man with a grown asymptomatic mass on the volar surface of right hand (hypothenar) remained for two years and impinging the skin of the hand only the last months. Initial MRI results diagnosed the mass as gaglion cyst. Histopathological examination revealed a schwannoma. We present this case as a rare manifestation of a schwannoma in hypothenar area of the hand. A literature review of diagnoses and therapeutic management is also presented.

scholarly journals Non-malignant Oral Ulcer: A Diagnostic Challenge to Otorhinolaryngologists

2019 ◽  
Vol 27 (3) ◽  
pp. 223-228
Author(s):  
Neeraj Aggarwal ◽  
Sirshak Dutta ◽  
Avijit Choudhury ◽  
Mainak Dutta ◽  
Saumik Das ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Clinical Diagnosis ◽  
Histopathological Examination ◽  
Oral Candidiasis ◽  
Tertiary Care ◽  
Diagnostic Challenge ◽  
Erosive Lichen Planus ◽  
Male Preponderance ◽  
Malignant Lesions ◽  
Malignant Ulcer

Introduction Apart from the malignant ulcers a wide variety of dermatological and other systemic conditions can affect oral cavity and often be a diagnostic challenge due to their similar presenting features and appearance. Despite being benign, some of them may be fatal if not diagnosed and treated timely. This study aims to assess the incidence of different non malignant ulcers in oral cavity and to estimate the need for histopathological examination for confirmation of the condition for proper management. Materials and Methods  An institution based observational study was conducted over a time period of 16 months at a tertiary care institute. Total 172 cases were included in the present study irrespective of age, sex and duration. Malignant lesions were excluded from the study. Results The present study shows a slight male preponderance (M:F = 1.48:1) with majority of cases were in age group 20-40 years of age (43.02%). Most commonly encountered were recurrent aphthous stomatitis (27.9%) followed by erosive lichen planus (16.28%), oral candidiasis, angular stomatitis, traumatic ulcers and others. 78.5% were treated successfully on the basis of clinical diagnosis while 21.5% cases needed further histopathological or other investigation for confirmation of diagnosis. Conclusion Though the otolaryngologists are more concerned about malignant ulcer, there are many non malignant ulcers which can cause significant morbidity and can even be fatal and should be given similar importance like malignant lesions. Majority of them can be treated successfully on the basis of clinical diagnosis but histopathological examination may be required in some cases for proper diagnosis and appropriate management.

scholarly journals Profile of Skin Biopsies and Patterns of Granulomatous Skin Diseases in a Tertiary Care Center of Western Nepal

2020 ◽  
Vol 3 (2) ◽  
pp. 288-293
Author(s):  
Ajay Kumar ◽  
Saujan Subedi ◽  
Jenny Pun ◽  
Binamra Basnet ◽  
Raja Babu Giri ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Care Center ◽  
Tertiary Care ◽  
Cost Effective ◽  
Skin Lesions ◽  
Clinical Impression ◽  
Clinicopathological Correlation ◽  
Diagnostic Challenge ◽  
Cross Sectional ◽  
Skin Biopsies

Background: Granulomatous skin diseases are one of the leading causes of morbidity in tropical countries like Nepal. These granulomatous skin lesions often pose diagnostic challenge to clinicians as well as to dermatopathologists. Histopathologic examination of a biopsy specimen represents one of the most informative and cost-effective procedure and may help to avoid other, costlier and invasive diagnostic workup. Materials and Methods: This cross-sectional observational study from October 2018 to October 2019, at department of dermatology, enrolled 142 cases of skin biopsies. Correlation between clinical impression and histopathological findings was evaluated. Results: Out of 13940 dermatology visits/ consultations, 142 (1.01%) skin biopsies were performed. Head, neck and face were the commonest sites of biopsies (29.6%). The most common biopsy technique was incisional type in 70 (50.4%). Histopathology showed granulomatous features in 49 (34.8%) cases, out of which tuberculoid type was the commonest, in 29 (58.0%). Positive clinicopathological correlation was seen in 117/142 (82.4%) for all biopsies and 41/49 (85%) for granulomaous skin lesions. Conclusion: Tuberculoid type was the most common cutaneous granuloma. High clinicopathological correlation in our study supports histopathology as an important tool for diagnosis of granulomatous as well overall skin disorders.

scholarly journals THE FEATURES OF SURGICAL TREATMENT AND MORPHOLOGICAL ASPECTS OF EPULIS AND PAPILLOMA IN CHILDREN

2021 ◽  
pp. 28-37
Author(s):  
P.I. Tkachenko ◽  
I.I. Starchenko ◽  
S.O. Bilokon ◽  
N.M. Lokhmatova ◽  
O.B. Dolenko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Giant Cell ◽  
Clinical Diagnosis ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Morphological Structure ◽  
Final Diagnosis ◽  
Histological Structure ◽  
Surgical Removal ◽  
Time Periods

The paper presents the findings of the study on the features of surgical treatment and morphological structure of epulis and papillomas in children. The clinical aspect of the paper concerns 123 children with epulis and 185 with papillomas, who were treated at the clinic of the Department of Pediatric Oral Surgery for the period of 10 years. Verification of the histological structure of neoplasms to determine the final diagnosis was performed by the faculty staff of the Department of Pathological Anatomy with Autopsy Course. Statistical processing of the digital data and analysis of the findings of the study showed that epulis and papillomas are more common in girls than in boys (in 2.5 and 2.3 times higher, respectively). A clear pattern of their diagnosis by age was established. Thus, the peak incidence of epulis was recorded in young adolescents of lower and higher secondary school ages (60.3% and 36.6%, respectively). Papilloma was also found quite often in the same age groups (47.0% and 31.4%, respectively). After comprehensive examination, the clinical diagnosis of the giant cell epulis was established in 21.1% of cases, and the share of its fibrous and angiomatous forms accounted for 35.0% and 43.9%, respectively. Neither patients with epulis of all its types nor their relatives could clearly determine the time periods of the appearance of the first clinical signs of the disease. All patients with papillomas and their relatives complained of the presence of newly formed masses on the oral mucosa or skin, which caused some discomfort, growing slowly, rarely reaching large sizes. The exact time periods of their occurrence could not be specified. Treatment of epulis, provided outpatiently for all patients under local anesthesia, was aimed at elimination of the etiological factor (if detected) and surgery. No recurrences were noted after removal of fibrous epulis and in cases of treatment of angiomatous epulis recurrence occurred in 1 girl. Among patients with giant cell epulis, recurrence after surgical removal was observed in 4 patients, 3 of whom underwent repeated surgery with preservation of teeth. In 1 child recurrence occurred for the third time and tooth extraction and partial resection of the alveolar ridge was made as part of the inpatient treatment. Treatment of papillomas involved surgical removal of neoplasms at the border of healthy tissue up to the submucosal layer using an electrocoagulator or radio knife. Depending on the clinical situation and localization of the tumor, manipulations were performed under local (161 cases - 87.0%) anesthesia at the polyclinic, and in 24 children (13.0%) with labile mental health and localization of papilloma on the soft palate, uvula, palatal arches, anesthesia was performed at inpatient. No complications during surgery and in the postoperative period were observed. The surgical material was always sent for histological examination, the results of which allowed determining one of the mentioned nosological forms. Morphological study has established, that the clinical diagnosis did not coincide with the morphological one in 5 cases (4.1%) in fibrous epulis, in 8 - 6.5% in angiomatous and in 10 - 8.1% in giant cell forms, which together made their discrepancy in 23 observations (18.7%). Thus, epulis and papillomas located in the oral cavity have a certain similarity in clinical symptoms and require careful differential diagnosis, and given their unique morphological structure, the final diagnosis must be established taking into account the findings of histopathological examination, as inconsistency of clinical and histopathological examinations, for example, in epulis, reaches 18.7%. When planning the treatment, in an every single case the type, extent and site of surgery, as well as type of anesthesia should be carefully considered. The presented material can serve as the basis for further in-depth scientific and practical research on comparison of clinical manifestations and immunohistochemical features of epulis and papillomas depending the age of patients.

scholarly journals Granulomatous lesions of the skin

1970 ◽  
Vol 1 (2) ◽  
pp. 81-86 ◽  
Author(s):  
K Gautam ◽  
RR Pai ◽  
S Bhat
Keyword(s):  
Skin Diseases ◽  
Histopathological Examination ◽  
Skin Lesions ◽  
Diagnostic Challenge ◽  
Modes Of Presentation ◽  
Supportive Role ◽  
Granulomatous Lesions ◽  
Granulomatous Dermatitis ◽  
Skin Biopsies

Background: Granulomatous skin lesions often present as a diagnostic challenge to dermatopathologists due to various modes of presentation and identical histological picture produced by several causes. The aim of the study was to study different granulomatous skin lesions and to determine the relative frequency, the level of clinicopathologic concordance and to compare our results with those of other workers. Materials and Methods: A retrospective analysis of skin biopsies received over a period of two years from January 2007 to December 2008; was performed, and cases of granulomatous dermatitis reported on histopathological examination were reviewed along with special stains. Results: Out of a total of 1590 skin biopsies 106 (6.67%) cases were found to have a granulomatous reaction. It was common in males (63.21%) with most occurring in the fourth to fifth decades. Majority of cases (79 cases, 74.5%) were categorized as infectious granulomatous lesions with predominance of leprosy (63 cases, 79.7%) followed by tuberculosis (6 cases, 7.6%). An overall clinicopathologic concordance was seen in 97% of cases of leprosy. Conclusion: In this study leprosy is the most common cause of granulomatous skin lesions. It can be concluded that histopathology plays an important role in classification of leprosy, and in diagnosis and management of a variety of granulomatous skin diseases. Special stains play a supportive role in infectious granulomas. Keywords: Granulomatous skin lesion; Leprosy; Skin biopsy DOI: http://dx.doi.org/10.3126/jpn.v1i2.5397 JPN 2011; 1(2): 81-86

scholarly journals Leiomyoma of the vulva: a diagnostic challenge

2018 ◽  
Vol 7 (3) ◽  
pp. 1246
Author(s):  
Shilpi Saxena ◽  
Suyash Goel ◽  
Alok D. Sen
Keyword(s):  
Smooth Muscle ◽  
Histopathological Examination ◽  
Critical Role ◽  
Final Diagnosis ◽  
Reproductive Age ◽  
Pathological Examination ◽  
Diagnostic Challenge ◽  
Duct Cyst ◽  
Smooth Muscle Tumors ◽  
Rule Out

Smooth muscle tumours of vulva are rare and therefore can be missed clinically. Our patient, 48-year-old lady presented with lump in the left vulva that was clinically diagnosed as Bartholin duct cyst. The lumpectomy was done under local anaesthesia and the lesion was sent for pathological examination. On gross examination the mass was 3.5 cm in diameter. The microscopic examination revealed the lump to be leiomyoma and no necrosis or atypia was present. The final diagnosis of “vulval leiomyoma” was given. Postoperative period was uneventful, and the patient is on regular follow up and there has been no recurrence. Leiomyoma should be kept as a differential diagnosis when a lady presents in late reproductive age group with unilateral swelling in vulvar region which is firm in consistency and the lump must be sent for histopathological examination for definitive diagnosis and rule out malignancy. The pathologists play a critical role in recognition and management of smooth muscle tumors of the vulva and to rule out leiomyosarcoma.

Congenital primary cerebral angiosarcoma

2000 ◽  
Vol 92 (3) ◽  
pp. 466-468 ◽  
Author(s):  
Yasuhiro Suzuki ◽  
Yasuko K. Yoshida ◽  
Reizo Shirane ◽  
Takashi Yoshimoto ◽  
Mika Watanabe ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Histopathological Examination ◽  
Good Condition ◽  
Clinical Manifestations ◽  
Final Diagnosis ◽  
Abdominal Ultrasonography ◽  
Content Type ◽  
The Central Nervous System ◽  
Specific Antigens

✓ Reports of angiosarcoma arising in the central nervous system are rare. The authors present the case of a 30-day-old infant with clinical manifestations of projectile vomiting and tense anterior fontanelle resulting from a left frontotemporal tumor. Total excision of this highly vascular, well-circumscribed tumor was performed without incident, and histopathological examination revealed a malignant angiosarcoma. Immunohistochemical reaction of the neoplastic cells was diffusely positive for endothelium-specific antigens including factor VIII-related antigen, CD31, and CD34. The final diagnosis of congenital primary cerebral angiosarcoma was thus confirmed. The patient's postoperative course was uneventful, and he was discharged 2 weeks after the operation. He was in good condition with no sign of recurrence after 11 months; follow-up computerized tomography, magnetic resonance (MR) imaging, and abdominal ultrasonography studies demonstrated no tumor regrowth. The characteristic findings for this tumor on MR imaging, the immunohistochemical findings, and surgical outcome are discussed.

scholarly journals Sarcoid Associated with Infection by Habronema spp. in Equines in Brazil

2016 ◽  
Vol 44 (1) ◽  
pp. 4
Author(s):  
Millena De Oliveira Firmino ◽  
Rodrigo Cruz Alves ◽  
Roberio Gomes Olinda ◽  
Manoel Simões Carneiro Júnior ◽  
Eldinê Gomes de Miranda Neto ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Skin Diseases ◽  
Histopathological Examination ◽  
Parasitic Infection ◽  
Differential Diagnoses ◽  
Semiarid Region ◽  
Neoplastic Tissue ◽  
Equine Sarcoid ◽  
Eosinophilic Cytoplasm ◽  
Cut Surface

Background: Equine sarcoid, supposed to be caused by infection with bovine papillomavirus type 1 or 2, is usually observedin previously traumatized skin areas, including lesions of habronemosis due to inoculation of third stage larvae in ulcerated wounds by Musca domestica or Stomoxys calcitrans. Little is known about the occurrence of diseases associated with equine sarcoid, mainly because limitations on clinical diagnosis, due to the different skin diseases that have to beconsidered as differential diagnoses. This report aimed to describe three cases of equine sarcoid associated with habronemosis in horses in the semiarid region of Northeastern Brazil.Cases: Three cases of sarcoid associated with habronemosis in equines were diagnosed at the Animal Pathology Laboratory of the Veterinary Hospital of the Federal University of Campina Grande, Patos, Paraíba. Case 1. A 5-year-old female showed in the ventral branch of the mandible a nodule of 3 cm in diameter, partially covered with skin and hair intercepted by areas of irregular surface with yellow-red ulcerations. The cut surface was formed by whitish and firm tissue. Case 2. It was a biopsy from a 4-year-old mare, who was not informed of the macroscopic characteristics of the lesion. Case 3. A 5-year-old horse presenting a nodular mass in the region of the tarsal-metatarsal joint, measuring 8.0x5.0x3.0 cm with an irregular, ulcerated, red-blackish surface. The cut surface was firm and whitish with brownish punctate areas. Microscopicallyall the lesions were classified as equine sarcoid of mixed type with abundant collagen fibers and randomly extensive proliferation of fibroblasts in the dermis. These fibroblasts had an elongated and weakly eosinophilic cytoplasm, rounded nucleus and prominent nucleoli. There were low mitotic activity. Hyperplasia, hyperkeratosis and sometimes ulcerated areas covered by serous cellular scabs were observed in the skin. Multifocal coalescing, granulomatous and eosinophilic lesions were observed within the neoplastic tissue. Cylindrical structures with an elongated thick eosinophilic outer cuticle and obvious side spicules, morphologically compatible with larvae Habronema spp, surrounded by inflammatory cells and cellular debris were observed in Cases 1 and 2. In case 3, intralesional larvae were not observed, but histologic lesions had a similar pattern than cases 1 and 2.Discussion: In these cases the affected animals presented simultaneously a mixed lesion of sarcoid and habronemosis, which leads to complications in clinical diagnosis and difficulties to institute appropriate therapy. Histopathological examination of such lesions is necessary because should characterize their morphology and the causative agent, discarding the other differential diagnoses. The combination of these two conditions can probably be related to the fact that sarcoid may develop up in places previously traumatized, such us lesions of habronemosis. It is important to differentiate these lesions from other skin diseases such as granulation tissue, pythiosis, squamous cell carcinoma and fibroid. Though the occurrence of sarcoid and simultaneous habronemosis in horses is rare in equine medicine, clinicians and pathologists who work with diagnosis may sporadically encounter similar cases, hence the importance of histopathologic analysis of skin samples, as this may help definition of the a etiology and also the institution of therapeutic measures and prognosis of affected animals.Keywords: equine skin disease, skin neoplasms, parasitic infection.

scholarly journals Epidemiology, Clinical and Laboratory Manifestations, and Outcomes of Brucellosis Among 104 Patients in Referral Hospitals of Tehran, Iran

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Amirreza Keyvanfar ◽  
Shahnaz Sali ◽  
Amir Zamani
Keyword(s):  
Treatment Failure ◽  
Financial Burden ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Diagnostic Challenge ◽  
Laboratory Findings ◽  
Elevated Alkaline Phosphatase ◽  
Cross Sectional ◽  
Dairy Consumption ◽  
Phone Calls

Background: Brucellosis is the most common zoonotic disease in Iran, imposing a significant financial burden on the healthcare system. The diversity of non-specific clinical manifestations of this disease can lead to misdiagnosis or delayed diagnosis. Therefore, it is important to pay attention to other aspects of this disease. Objectives: This study aimed to determine the epidemiology, clinical and laboratory manifestations, and outcomes of brucellosis. Methods: In this cross-sectional study, brucellosis patients, admitted to three hospitals, affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran) from April 2015 to September 2020, were examined. The patients' medical records were reviewed for epidemiological, clinical, and laboratory findings. The outcomes of the disease were evaluated by phone calls. Results: Of the 104 patients included in this study, 53.8% were male, and 46.2% were female. The mean age of the patients was 43.07 ± 18.521 years. Unpasteurized dairy consumption and contact with livestock were reported in 60.6 and 27.9% of the patients, respectively. Also, 23.1% of the patients had high-risk occupations. The most common symptoms included fever (80.8%), chills (58.7%), backache (55.8%), and sweating (51%). The most common complication was osteoarticular involvement (21.2%), followed by neurobrucellosis (6.7%). Elevated alkaline phosphatase (89.7%), anemia (67.3%), increased C-reactive protein (57.7%), and increased erythrocyte sedimentation rate (48.1%) were common laboratory findings. The rates of improvement, treatment failure, and relapse were 86.9, 9.1, and 4%, respectively. There was no significant relationship between the rate of improvement and the antibiotic regimen. However, the most common cause of treatment failure was the patient’s poor compliance with treatment. Conclusions: The diversity of non-specific clinical manifestations of brucellosis is a diagnostic challenge. Therefore, physicians must request laboratory tests to evaluate brucellosis after taking a precise epidemiological and clinical history of suspected cases.

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