Frequency of endoscopic findings of equine squamous gastric disease (ESGD) in rural horses and its association with Helicobacter pylori virulence genes

Equine gastric ulcer syndrome (EGUS) is a multifactorial disorder and one of the most common diseases in horses. The objective of this research was to detect one of the potential risk factors of equine squamous gastric disease (ESGD), the Helicobacter pylori specific gene, and tracing the presence of the duodenal ulcer-promoting gene (dupA) as a possible virulence marker. Gastric fluid together with faecal samples were collected from twenty rural horses from around Tabriz, Iran. Throughout the endoscopic examinations, the type, numbers, severity, and the location of the lesions were documented. Nine of twenty horses exhibited macroscopic lesions in the squamous mucosa that were later classified into grades 1, 2, 3, and 4. Only three of these horses exhibited H. pylori in their gastric fluid samples, whereas all faecal samples were H. pylori-negative. All the H. pylori-positive cases manifested severe forms of ESGD (grades 3–4). The age and sex were both unrelated to the lesion severity and ESGD status in this study. Research is required to further discuss the virulence aspects of dupA regarding ESGD.

Dicyclomine-Induced Esophagitis Dissecans Superficialis

Introduction/Objective Esophagitis dissecans superficialis (EDS) is a rare benign condition of the esophagus, characterized by desquamation of superficial epithelium of the esophageal lining. Etiology is uncertain, considered idiopathic in most cases. EDS can be associated with medications, hot beverages, chemical irritants, celiac disease and skin bullous disorders. It has a predilection for the distal and/or middle esophagus. Methods/Case Report We report a case of a 25-year-old otherwise healthy female with mild gastrointestinal symptoms over 3 years. Her symptoms had worsened over a period of 2-3 weeks, and she complained of lower abdominal cramping associated with constipation. No rectal bleeding or melena was reported. Labs including complete blood count and comprehensive metabolic panel were within normal range values. A presumptive diagnosis of irritable bowel syndrome was made by gastroenterologist. Antispasmodic drug, Dicyclomine 10 mg capsule (a blue capsule), was prescribed. After 4 weeks, a scheduled esophagogastroduodenoscopy revealed patchy plaque-like mucosal changes, characterized by blue discoloration, in the upper third of esophagus. Microscopically, biopsy showed strips of squamous mucosa with a thick layer of parakeratosis, basal cell hyperplasia and foci of minimal inflammation. There were multiple transverse splits at different levels in the parakeratotic layer. A pathologic diagnosis of EDS was established. A further clinical investigation demonstrated that the patient was swallowing medication without water. Results (if a Case Study enter NA) NA Conclusion In conclusion, we present the first case of Dicyclomine-Induced EDS secondary to an irritant effect of waterless medication ingestion. Recognition of this rare entity and clinical correlation are important as it can pose a diagnostic challenge to pathologists and clinicians.

Acute oesophageal necrosis in a patient with recent SARS-CoV-2

A 57-year-old Hispanic man with diabetes presented with dyspnoea. He had a positive SARS-CoV-2 PCR. He was intubated for severe hypoxia and treated with intermittent pressors, methylprednisolone and supportive care. He was extubated on hospital day (HD) 9 and discharged to a skilled nursing facility (SNF) on HD 18. Approximately 1 month later, he presented with melena. Endoscopy revealed two large 1.5–2 cm wide-based distal oesophageal ulcers without active bleeding. Histology showed ulcerated squamous mucosa with extensive necrosis extending to the muscularis propria and coccoid bacterial colonies with rare fungal forms suggestive of Candida. He was treated with fluconazole and pantoprazole and was discharged to a SNF. Approximately 3 weeks later, he was readmitted for complications. Repeat endoscopy demonstrated improvement and histology revealed chronic inflammation with reactive epithelial changes. Incidentally, SARS-CoV-2 PCR was positive during this visit without any respiratory symptoms.

Expression CMTM6 and PD-L1 and Their Significance in Cervical Squamous Cell Carcinomas

Background: This study aimed to investigate the expression levels of chemokine-like factor-like MARVEL transmembrane domain-containing family member 6 (CMTM6) and PD-L1 in cervical squamous cell carcinoma and their clinical significance. Methods: We used immunohistochemistry to detect the expression of CMTM6 and PD-L1 in 41 cases of normal cervical squamous mucosa tissue and 76 cervical squamous cell carcinomas. Chi-square test was used to analyze the difference of CMTM6 between cervical squamous carcinoma and normal squamous mucosa. Results: The results showed that the expression of CMTM6 and PD-L1 in cervical squamous carcinoma was significantly higher than that in normal squamous mucosa (p<0.05). There is a positive correlation between the expression of CMTM6 and PD-L1 in cervical squamous carcinoma (p<0.05). There is no correlation between CMTM6 and HPV infection in cervical squamous carcinoma. In addition, CMTM6 expression is positively correlated with lymph node metastasis and nerve invasion for cervical squamous carcinoma (p<0.05). PD-L1 expression is positively correlated with the differentiation of cervical squamous carcinoma. Conclusions: The expression of CMTM6 and PD-L1 is closely correlated in cervical squamous carcinoma , and may be used as a molecular target for cervical cancer in the future.

A PAX-8-positive Female Urethra Adenocarcinoma: A Case Report with Diagnostic Challenges in Intestinal- Type Adenocarcinoma

Introduction/Objective Female urethra adenocarcinoma (FUA) in women is extremely rare, representing 0.02% of all women’s cancers and &lt;1% of cancers in the female genitourinary tract. Intestinal-type primary adenocarcinoma of the urethra is even rarer, with only one documented case to our knowledge. Furthermore, PAX-8 immunoexpression in this entity has not been reported. Here we report an intestinal-type primary urethral adenocarcinoma that developed from inflammation-related metaplasia in urethral diverticulum with positive PAX-8 staining. Methods Clinical chart review and microscopic examination on the lung, urethral, and vaginal wall biopsies and immunohistochemistry were performed. Results A 64-year-old female with a 32-pack-year history of tobacco use was found to have multiple pulmonary nodules on imaging. The tumor cells were positive for CK7, CK20, SAT-B2, and PAX-8 and negative for TTF- 1/Napsin and ER. Positive PAX-8 immunoexpression raised the possibility of a gynecologic/Mullerian primary. Subsequent colonoscopy and imaging showed no evidence of colorectal or uterine tumors. The patient began having hematuria with intermittent urinary retention, and cystoscopy showed a 4 x 3 cm mass involving bladder neck circumferentially and invading into the vaginal wall. Urethral and vaginal tumor biopsies were performed. Morphologic examination of the urethral biopsy demonstrated intestinal metaplasia of squamous mucosa with transition from a mature to dysplastic phenotype where the adenocarcinoma originated from. The vaginal wall biopsy showed the same morphology. The urethral and vaginal wall biopsies showed a similar immunophenotype as the pulmonary nodule biopsy. Conclusion FUA is a rare, aggressive tumor that occurs in Skene’s glands. In our current case, however, it appeared to arise from inflammation-related metaplasia in urethral diverticulum. Another important finding of the case is the positive PAX-8 expression. Therefore in PAX-8 positive tumors, primary adenocarcinoma of lower urinary tract should be in the differential, along with gynecologic/Mullerian tumors.

Primary Intestinal-type Adenocarcinoma of the Vulva Causing Secondary Extramammary Paget Disease

Casestudy A 65-year-old woman with a known history of anogenital extramammary Paget disease presented with a pedunculated lesion arising from the vulvar vestibule near the urethral meatus, discovered during a routine surveillance exam. Results Biopsy of the lesion revealed an adenocarcinoma with villoglandular architecture and pseudostratified columnar epithelium with goblet cells that is arising in direct continuity with the uninvolved squamous mucosa. In addition to the villoglandular component, an area of dyscohesive cells with signet ring morphology within a mucinous background was present. Biopsy of a lesion inferior to the index mass showed Paget disease with similar morphology to the invasive adenocarcinoma. By immunohistochemistry (IHC), the invasive adenocarcinoma was diffusely positive for CK20, CK7, and CDX-2 with patchy staining for p16. Metastasis was excluded by colonoscopy, mammography, and PET-CT. Additional IHC stains for GCDFP-15, GATA-3, PAX-8, S100, p63, and PSA were all negative on subsequent biopsies performed for mapping the extent of disease. These features supported a diagnosis of primary intestinal-type adenocarcinoma of the vulva and pointed to this tumor as a source of her Paget disease. Conclusion Primary intestinal-type adenocarcinomas of the vulva are extremely rare with only a small number of case reports in the literature. It is suggested that these tumors acquire a colorectal phenotype due to the cloacal origin of the vulvar vestibule. No standard treatment approach has been developed due to the rarity of this disease, but the majority of reported cases have had an indolent course. To the best of our knowledge, other than this case, there is only a single additional case report in the literature of secondary Paget disease arising from this tumor type. We underscore the propensity of this tumor to cause secondary Paget disease, mimicking spread from a colorectal primary site.

Surveillance of neo-squamous epithelium after ablation of Barrett’s esophagus: is it better to use jumbo over standard biopsy forceps?

Summary Background and Aims: As obtaining adequate tissue on biopsy is critical for the detection of residual and recurrent intestinal metaplasia/dysplasia in Barrett’s esophagus (BE) patients undergone Barrett’s endoscopic eradication therapy (BET), we decided to compare the adequacy of biopsy specimens using jumbo versus standard biopsy forceps. Methods: This is a two-center study of patients’ post-radiofrequency ablation of dysplastic BE. After BET, jumbo (Boston Scientific©, Radial Jaw 4, opening diameter 2.8 mm) or standard (Boston Scientific©, Radial Jaw 4, opening diameter 2.2 mm) biopsy forceps were utilized to obtain surveillance biopsies from the neo-squamous epithelium. Presence of lamina propria and proportion of squamous epithelium with partial or full thickness lamina propria was recorded by two experienced gastrointestinal pathologists who were blinded. Squamous epithelial biopsies that contained at least two-thirds of lamina propria were considered ‘adequate’. Results: In a total of 211 biopsies from 55 BE patients, 145 biopsies (29 patients, 18 males, mean age 61 years, interquartile range [IQR] 33–83) were obtained using jumbo forceps and 66 biopsies (26 patients, all males, mean age 65 years, IQR 56–76) using standard forceps biopsies. Comparing jumbo versus standard forceps, the proportion of specimens with any subepithelial lamina propria was 51.7% versus 53%, P = 0.860 and the presence of adequate subepithelial lamina propria was 17.9% versus 9.1%, P = 0.096 respectively. Conclusions: Use of jumbo forceps does not appear to have added advantage over standard forceps to obtain adequate biopsy specimens from the neo-squamous mucosa post-ablation.

Pathomorphological study on gastric ulceration in horses

Equine gastric ulcer syndrome (EGUS) is characterized by ulceration in the terminal esophagus, proximal (squamous) stomach, distal (glandular) stomach, and proximal duodenum. It is a common disease in all breeds and ages of horses and foals. Risk factors for EGUS include stress, transport high-energy feed confinement in stalls, intermittent feed, and intense exercise and racing. Horses are very sensitive to any environmental change, which is cause of high prevalence of gastric ulcers especially in racing horses. Taking into consideration of high prevalence of EGUS, our research work was based on pathomorfological and gross evaluation of gastric mucosa in different breeds of horses. Assessment of the severity of lesions is most commonly achieved by assigning a grade that describes the mucosal appearance at different anatomic sites. A variety of different systems have been published for the horses. 10 stomachs were removed from a mixed population post mortem. In our study pathological classification of lesion type was evaluated by two different scoring system, with scales ranging from 0–4. Samples from areas with lesion were taken for histopathology evaluation. EGUS was confirmed on stomachs of six horses. Lesions with different score mostly localized on squamous region near margo plicatus. Changes on squamous mucosa was confirmed on stomach of four horses as well as glandular region two horses. According to score systems mentioned in publication changes on gastric mucosa was measured up 1, 2, 3 score and were characterized as hyperceratosis, erosions and deeper lesion involving the mucosa, extending to the submucosa layer and hyperemia of glandular mucosa. The results of pathomorphological examination of the condition of the wall of the gastric mucosa and histological changes, the effectiveness of the submitted classification systems was established.

Perianal Goblet Cell Carcinoid With Pagetoid Spread

We present a case of perianal goblet cell carcinoid with pagetoid spread. Goblet cell carcinoid, also known as adenocarcinoid tumor, predominantly arises as a primary appendiceal tumor and contains nests of neuroendocrine and mucin-containing cells. When this tumor type is seen in other sites it usually represents a metastasis. We present the case of an 81-year-old woman with a perianal mass. Histologic and immunohistochemical examination following surgical excision showed a goblet cell carcinoid demonstrating pagetoid spread along the perianal squamous mucosa. There was no evidence of a primary appendiceal tumor by history or imaging studies. To our knowledge, this is the first report of a goblet cell carcinoid presenting in this manner. The patient died due to complications of metastatic disease 26 months after initial diagnosis.