A Rare Case of Adult Medulloblastoma Associated with Multiple Sclerosis: Case Report and Literature Review

Medulloblastomas are the most common primary malignant brain tumors in childhood. They are responsible for around 20–40% of all brain tumors in children. They rarely occur in adulthood, but here they only make up less than 1% of all brain tumors. The standard therapy consists of an operation in combination with radiation and chemotherapy, which are individually determined for the patient. In this article, we discuss a case of 47 years old female patient diagnosed with primary progressive multiple sclerosis since 1 year. After 3 months of the diagnosis, she deteriorated and became unable to walk. MRI showed a large patchy enhancing midline cerebellar mass with evolving hydrocephalus. Tumor expressed positive reaction with synaptophysin immunohistochemical stain rendering medulloblastoma diagnosis.

Pathological Features of COVID-19 Pneumonia Diagnosed Following an Autopsy

After initial emergence at the end of 2019, coronavirus disease 19 (COVID-19) rapidly spread to become a pandemic. The causative agent is recognized as a novel coronavirus, named as severe acute respiratory syndrome coronavirus 2, which is known to primarily affect the respiratory system. We present the case of a 60-year-old man who was diagnosed to have COVID-19 pneumonia following an autopsy. Microscopic examination of the lung tissue showed acute (exudative) phase of diffuse alveolar damage, inflammatory infiltrates in alveolar spaces and interstitium, atypical pneumocytes with prominent nucleoli and expanded cytoplasm, and thrombi in small arterioles. Some megakaryocytes were observed, which were positive for immunohistochemical stain for CD61. The pathological findings observed in this case were consistent with those of previously published reports of COVID-19 pneumonia. This is the first case of COVID-19 pneumonia diagnosed with an autopsy in Korea.

Expression of ERG immunohistochemical stain in prostatic adenocarcinoma

Objective: The objective of my study is to investigate the incidence ERG fusion positive adenocarcinoma and its correlation with gleason grade and gleason group. Methods: it is a descriptive cross sectional study. 100 cases of prostatic adenocarcinoma were retrieved and ERG immunohistochemical stain was applied on all these cases. ERG expression, extent of staining, percentage of tumor cells positive for ERG, pattern of staining were recorded. We found out relationship of ERG expression and gleason grade/ gleason group. Results: ERG expression was seen in 62/100 (62%) cases. mean patient age of ERG positive prostatic adenocarcinoma patients was 69.68years. In GG1 (14.5%) 9 cases exhibited ERG positivity. In GG2-3, 41.93% cases and in GG4-5, 43.54% cases showed ERG expression. Conclusion: To conclude, age of presentation of ERG positive adenocarcinoma was high. ERG expression was seen in 62% of our cases which was much higher than reported in other Asian countries. In our study we found a significant correlation between ERG expression and high gleason grade group.

Sarcomatoid Mesothelioma: A Clinicopathological and Immunohistochemical Study of 64 Cases

Sixty-four cases of sarcomatoid pleural mesothelioma represent the basis of this study. The patients are 51 men and 13 women between the ages of 42 and 79 years, who presented with symptoms of chest pain, cough, and weight loss. Diagnostic imaging showed the presence of diffuse pleural thickening with encasement of the lung parenchyma in all the cases. All patients had surgical resection via extrapleural pneumonectomy. By immunohistochemistry, all cases were positive for cytokeratin AE1/AE3; however, reactivity with other markers including keratin 5/6, calretinin, and D2-40 was seen in different proportions, whereas a few cases showed positive staining for GATA3, WT1, and p40. All tumors were negative for carcinomatous epitopes (carcinoembryonic antigen, CD15, and TTF1). Our findings show that even though the use of immunohistochemical stains plays an important role in the final interpretation, the best results are accomplished by a global interpretation of clinical, radiographical, and immunohistochemical findings. It is also important to highlight that it does not seem to be a single immunohistochemical stain that is pathognomonic of sarcomatoid mesothelioma and that some other stains that are commonly used for other tumors may also show positive staining in a small percentage of sarcomatoid mesotheliomas.

Arare bone metastasis of mammary carcinoma in a female dog: case report

Mammary gland tumors are the most frequent neoplasm in dogs and are mostly malignant. Metastases ordinarily occur firstly at the pulmonary level, and subsequently in the lymph nodes, liver and kidneys. Less frequently, they appear at the bone. Therefore, the present study report a case of bone metastasis in a seven-year-old female boxer dog, consisting of poorly differentiated carcinoma that probably originated from mammary carcinoma. For the diagnosis, the bone biopsy was performed and the tissue fragmentsobtained were sent for histopathological examination. The positive immunohistochemical stain for cytokeratin 7 performed later reinforced the hypothesis that mammary carcinoma was the primary site of metastasis. The occurrences of bone metastases arising from the mammary gland are rare among dogs, possibly because metastasis is underdiagnosed and the animals do not reach the final stage of the disease. Thereby, there is a need to investigate the entire skeleton more accurately, in order to make an early diagnosis of bone metastasis and increase these animals’ survival.

Correlation of Hemophagocytosis with Clinical Criteria of Hemophagocytic Lymphohistiocytosis and Recommendations for Screening Bone Marrow Samples in Adult Patients

Introduction Hemophagocytic lymphohistiocytosis (HLH) is a rare condition resulting from a dysregulated inflammatory response. It can prove difficult to diagnose and portends a poor prognosis. Bone marrow (BM) biopsy is an easily accessible test that is often used to identify the presence of hemophagocytosis and assess for underlying malignancy. Currently there are no evidence-based guidelines on the reporting of hemophagocytosis on BM biopsy and no reports of a correlation between hemophagocytosis with the clinical diagnostic criteria for HLH. We therefore aimed to assess if the amount of hemophagocytosis identified in the BM biopsy correlates with HLH-2004 criteria. Secondary aims were to evaluate inter-observer variability in reporting hemophagocytosis, and to formulate recommendations for screening in BM specimens. Method A retrospective review of bone marrow biopsies from adult patients under investigation for HLH was undertaken independently by 2 hematopathologists who were blinded to the original biopsy report. Relevant clinical and laboratory data was extracted from medical records. The average number of actively hemophagocytic cells in each slide prepared from BM aspirates were quantified into 0, 1, 2-4 and ≥5. On trephine samples, hemophagocytosis was reported as either 'present' or 'absent', with the assistance of the CD68 immunohistochemical stain. Cases with discordance pertaining to the degree of hemophagocytosis were reviewed by both assessors to reach a consensus. Results Sixty-two specimens from 59 patients were available for assessment. An underlying hematological condition was identified in 34 cases (58%). The most common underlying hematological condition was lymphoma, found in 15 cases (25%). There was a significant association between the amount of hemophagocytosis identified on the aspirate samples and the number of HLH-2004 criteria met (p<0.05). In patients where hemophagocytosis was present (n=31), there was a significant correlation between the amount of hemophagocytosis and ferritin levels (p<0.05). Interobserver variability was present in 63% of cases. Based on our review, we make the following recommendations for reporting of hemophagocytosis in the BM samples:> 1. Count only macrophages ingesting intact hemopoietic cells. W2. Quantify the average number of active histiocytes per aspirate slide. W3. Count histiocytes away from particles where the cellular outline is clear. W4. Avoid counting conglomerates of histiocytes where the cellular margins are indistinct W5. On the aspirate specimen, assess for hemophagocytosis on both the trail and squash preparations. W6. Delineating hemophagocytosis on trephine samples is difficult without the use of a CD68 immunohistochemical stain. Interestingly, a study by Ho et al found no association between the BM histologic findings and the probability of hemophagocytosis (Ho et al, American Journal of Clinical Pathology, 2014). This difference highlights the need for standardised reporting of BM specimens. Conclusion Our findings indicate that the amount of hemophagocytosis present on BM samples correlates with the number of HLH-2004 criteria met. We found marked interobserver variability which we anticipate can be rectified with our recommendations on the reporting of hemophagocytosis. Disclosures Talaulikar: Takeda: Research Funding; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau.

Low-concentration sevoflurane inhalation in treating MK801-induced schizophrenia like disease in mice and a feasibility study of schizophrenia patients

GABAergic deficits have been considered to associate with the pathophysiology of schizophrenia and hence GABA receptor subtype A (GABAARs) modulators may have therapeutic values for schizophrenia. Sevoflurane, a commonly used volatile anesthetic, enhances GABAergic neurotransmission through the GABAAR. The present study aims to investigate the therapeutic effectiveness of low-concentration sevoflurane in MK801-induced schizophrenia-like mice and amongst schizophrenia patients in a single arm trial. Three weeks after administration of MK801 (0.5 mg/kg, i.p. twice a day) for five days, mice were exposed to 1% sevoflurane for 1 hr/day for 5 days. One week after treatment, they were subjected to behavioral tests, and then sacrificed for immunohistochemical stain, western blot assay and electrophysiology recordings in the prefrontal cortex. Ten schizophrenia patients received 5-hr sevoflurane (0.5–1.2%) for 6 days, and were assessed with the PANSS and the BPRS-18 in the 1st and 2nd week after the treatments. MK801 induced hypolocomotion and social deficits, downregulated the expression of NMDARs subunits, and postsynaptic density protein 95 (PSD95), reduced parvalbumin- and GAD67-positive neurons, and changed the amplitude and frequency of mEPSC and mIPSC and evenly increased the excitation/inhibition (E/I) ratio. All these changes induced by MK-801 were attenuated by sevoflurane administration. Schizophrenia symptoms assessed with the scales were significantly improved in the 1st and 2nd week after treatments. Low-concentration sevoflurane inhalation effectively reversed MK801-induced schizophrenia-like disease in mice and alleviated schizophrenia patients’ symptoms. Our work suggested that sevoflurane may be a valuable therapeutic strategy for treating schizophrenia patients.