Anisakis pegreffii Larvae in Sphyraena viridensis and Description of Granulomatous Lesions

The aim of the present study was to describe gastric granuloma caused by Anisakis pegreffii in Sphyraena viridensis caught in the central Mediterranean Sea. Sixty-eight S. viridensis specimens were collected from different fish markets on the east coast of Sicily. Coelomic organs were observed both macroscopically and with the aid of stereomicroscope. Parasite specimens and lesioned tissues were collected for identification, histological and molecular analyses. Twelve specimens (p = 17.6%) were positive for the presence of nematode larvae, morphologically identified as larvae of Anisakis sp., with values of mean abundance and mean intensity of 0.9 and 4.8, respectively. One large female specimen showed massive parasite infection associated with nodular lesions of the gastric wall. By histology, several nematode larvae encysted through the gastric wall were found. The parasite bodies were surrounded by a granulomatous reaction made up of macrophages, epithelioid cells, some lymphocytes and an external connective sheet. Molecular analysis of 18S rRNA and cox2 genes from Anisakis sp. collected larvae, identified them as A. pegreffii. The lesions here described, though macroscopically superimposable on human eosinophilic granuloma, microscopically showed significant differences in the inflammatory cells involved and in the type of immune reaction.

Autologous adipose-derived mesenchymal stem cells and hydroxyapatite for bone defect in rabbits

This study aims to evaluate the effect of autologous adipose-derived mesenchymal stem cells (AAD-MSC), with and without synthetic absorbable hydroxyapatite (HAP-91), on the bone regeneration in rabbits. Thirty-four female white New Zealand rabbits were submitted to a 10 mm distal diaphyseal radius ostectomy, divided into 3 experimental groups according to the treatment established. The bone gap was filled with 0.15 ml of a 0.9% saline solution containing two million AAD-MSC (G1), or AAD-MSC associated with HAP-91 (G2). The control group (CG) received only 0.15 ml of the 0.9% saline solution. Radiographs were made post-operatively, and after 15, 30, 45 and 90 days. Fifty percent of the samples were submitted to a histological examination at 45 days and the remaining ones at 90 days post-operatively. Radiographically, the periosteal reaction, bone callus volume and bone bridge quality were superior in G2 (P < 0.05). Histologically, the bone repair was faster and more efficient in G1 at 45 days (P < 0.05). In conclusion, AAD-MSC improved the regeneration on the experimentally induced bone defects in rabbits; however, the use of hydroxyapatite requires caution given the granulomatous reaction produced in the species.

Histopathological Aspects of Cutaneous Leishmaniasis due to Leishmania-Major in Libya

Aims: To describes the histopathological characteristics of skin lesions from patients with cutaneous leishmaniasis caused by Leishmania major in northwestern Libya and correlate with clinical presentation. Study Design: case series study. Place and Duration of Study: This study was carried on patients referred by the region's healthcare institutions and those presented at the Tripoli Central Hospital or the Libyan National Centre for Disease Control between July 2017 to January 2018. Methodology: The study included 38 patients, aged between 1-73 years, of both sexes, and came from 18 endemic areas in North-Western of Libya. The inclusion criteria were clinical symptoms and microscopic visualization of the parasite on a Giemsa-stained skin smear, in addition, clinical by the slit and smear technique, polymerase chain reaction for L. major. In addition, statistical analysis was conducted for the Histopathological examination. Results: The study found that 36 (94%) of the cases studied were positive by the slit and smear technique, and 32 (88.9%) were positive by PCR for L. major. Five histopathological patterns were observed: (i) diffuse cellular reaction without necrosis (25%); (ii) diffuse cellular reaction with necrosis (31.3%); (iii) exudative and necrotic granulomatous reaction (25%); (iv) exudative granulomatous reaction without necrosis (9.3%); (v) exudative-tuberculoid reaction with typical tuberculoid granuloma (organized) (9.3%). Inflammatory cellular infiltration ranged from mild to severe. Lymph plasmacytosis and lymph histiocytosis were predominant (34.4% and 21.7%, respectively). Necrosis was diffuse or local. The clinical features were correlated with this histological pattern. Epidermal changes included acanthosis, exocytosis, spongiosis, hyperkeratosis, and atrophy. Conclusion: The histopathological changes observed in CL caused by L. major in North-Western of Libya are characterized by an intense diffuse inflammatory reaction in the dermis with the predominance of lymphoplasmacytic infiltration. Overall, the granulomatous presentation was the main one. Various clinical forms, including papule, plaque, erythematous nodule with hemorrhagic crust, or violaceous nodule with adherent crust and ulcerated nodule, are significantly correlated with the histopathological stages, whereas disease progression could be related to age. The histopathological diagnosis of CL caused by L. major has a sensitivity of 78% relative to PCR.

Challenging Mimickers in the Diagnosis of Sarcoidosis: A Case Study

Sarcoidosis is a systemic granulomatous disease of unknown cause characterized by a wide variety of presentations. Its diagnosis is based on three major criteria: a clinical presentation compatible with sarcoidosis, the presence of non-necrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. Many conditions may mimic a sarcoid-like granulomatous reaction. These conditions include infections, neoplasms, immunodeficiencies, and drug-induced diseases. Moreover, patients with sarcoidosis are at risk of developing opportunistic infections or lymphoma. Reliably confirming the diagnosis of sarcoidosis and better identifying new events are major clinical problems in daily practice. To address such issues, we present seven emblematic cases, seen in our department, over a ten-year period along with a literature review about case reports of conditions misdiagnosed as sarcoidosis.

Granuloma formation after injection of polycaprolactone dermal filler (case report)

A case of clinical observation of a patient with a granulomatous reaction developing in the region of both nasolacrimal grooves after the injection of a filler based on polycaprolactone (PCL) is presented. PCL is used in cosmetology as a filler and collagen synthesis stimulator. It is a biocompatible and biodegradable polymer with a proven safety profile. However, as with the introduction of other types of fillers, in some cases it can cause a granulomatous reaction of varying severity. The clinical observation of this case is of interest to practicing dermatologists, cosmetologists and plastic surgeons.