Hepatic Hyaline Arteriolosclerosis in Patients with Chronic Hyperglycemia

Introduction/Objective Hyaline arteriolosclerosis is a common feature of diabetic microangiopathy. It results from hyperglycemia-induced endothelial cell dysfunction and can be found in many sites including the retina, kidney, and skin. This histologic finding is important because studies have shown that in the kidney it is an independent risk factor for cardiovascular complications. To our knowledge, an association between hyperglycemia and hyaline arteriolosclerosis in the liver has not be studied. We aimed to investigate whether chronic hyperglycemia is associated with this histologic finding in liver arterioles. Methods/Case Report The first 50 liver biopsies performed at our institution starting January 1, 2020 were scanned into a digital pathology system (Philips, Cambridge, MA). For each biopsy, the patient’s highest recorded hemoglobin A1c (HbA1c) up to one year from the date of biopsy was recorded. The biopsies were then grouped into two groups: those from patients with a HbA1c greater than 6.5%, and those with a HbA1c value less than 6.5 %. Next, the digested periodic acid Schiff (DPAS) intensity of the arteriolar vessels in each biopsy was graded 0 to 3 by a single pathology resident who was blinded to its corresponding HbA1c group. Grade 0 to 1 was considered negative staining. Grade 2 to 3 was considered positive staining and indicative of hyaline arteriolosclerosis. By the end of the data collection, each case had been given a staining category and a HbA1c group. A 2 x 2 contingency table was constructed. Results (if a Case Study enter NA) 37 of 50 patients had a recorded HbA1c meeting the study criteria. Of these 37 patients, 11 had an HbA1c greater than 6.5 % while 26 had an HbA1c less than 6.5%. Seven of the 11 biopsies from patients with an elevated HbA1c showed positive staining. Six of the 26 biopsies from patients with an HbA1c less than 6.5% showed positive staining. Conclusion We hypothesized that patients living with hyperglycemia may be more likely to exhibit hepatic hyaline arteriolosclerosis. A chi-squared test of independence was performed to examine the association between a liver biopsy’s HbA1c group and staining category. The relation between these variables was significant at p = < .05, χ 2 (2, N= 36) = 5.57, p = .0182, indicating liver biopsies with a HbA1c greater than 6.5 % are more likely to have this histologic finding. Future studies are needed to characterize diabetic hepatopathy, and its relatedness to macrovascular complications.

Giant cell lesions: A diagnostic mystery, case report and review of literature

Giant cell lesions is a broad term encompassing a wide range of lesions that are biologically and morphologically diverse with an uncertain aetiology, whether it is a benign tumour, reactive lesion, inflammatory lesion or a self-healing lesion is ill understood. Their relation to each other also is not very clearly defined as they differ in their clinical and radiographic characteristics and their only similarity is in the histologic finding of non-neoplastic osteoclast like giant cells of different lineage. Owing to this fact their exact diagnosis continues to be one of the most obscure making them a dilemma, leaving many questions regarding their treatment and prognosis unanswered. Here we present a case of Central Giant Cell Tumor that was misdiagnosed as fibrous dysplasia that lead to an elusive treatment plan.

Reparative Perineural Hyperplasia in the Gastric Wall: A Histologic Mimic of Perineural Invasion

Reparative perineural hyperplasia is an incidental and probably underreported reactive histologic finding thus far only reported in the setting of healing wounds or adjacent to a dermatofibroma in cutaneous specimens. It is characterized by a focal concentric proliferation of cytologically bland spindled perineurial cells and is hence considered a benign histologic mimic of neoplastic perineural invasion. Thus, it may present a diagnostic pitfall and we therefore consider it as a valuable entity to be aware of. To the best of our knowledge, this brief case report is the first to convey that reparative perineural hyperplasia may also occur in the gastrointestinal tract. It may therefore be a ubiquitous reactive histological phenomenon relating to previous surgical or traumatic wounds in various sites, that is, outside the thus far established setting of skin reexcision specimens.

Decidual Granulomata of Unclear Significance

Granulomatous inflammation is a histologic finding with a relatively wide variety of causes. In general, considerations include infectious etiologies, autoimmune conditions, or foreign body reactions. Granulomatous inflammation is uncommonly seen in the placenta. We present a unique case of a young woman with preterm labor and rupture of membranes whose placenta demonstrated perivascular decidual granulomata in the membranes and the basal plate.

Renal cell carcinoma with ipsilateral duplex system: Case report and review of literature

Renal cell carcinoma is the most common malignant renal tumour in adults but quite rare in children. Duplex renal collecting systems are relatively common congenital renal abnormalities. However, its coexistence with renal cell carcinoma is yet to be established beyond a mere coincidence. So far, there are only 2 cases of such coexistence in literature till date. We therefore report a case of a 13-year-old girl who was referred to us with a right flank mass. Abdominal computerized tomographic scan revealed a right renal tumour necessitating a laparotomy at which a duplex collecting system was discovered in the ipsilateral kidney and a nephrouterectomy was done with a histologic finding of renal cell carcinoma. We report this rare relationship and review of literature to stimulate further study into this rare association.

Multiple Myeloma with Intracytoplasmic Azurophilic Granules

Bone marrow examination plays an important role in the diagnosis of multiple myeloma. In some cases with multiple myeloma, marrow plasma cells with cytoplasmic inclusions are seen. In this study, a 46-year- old man was evaluated for multiple myeloma. In bone marrow aspiration, large intracytoplasmic azurophilic granules, resembling intracellular microorganisms were seen. IHC study demonstrated that these cells are CD138 positive. This is a rare histologic finding that usually results from the deposition of excess immunoglobulin.